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ADMISSION FORM Date: / / 2 0 1 1

Please tick the program you are applying for:

o
MBA (Oil & Gas Management)

o
MBA (Power Management) Affix
Photograph
o
MBA (Logistics & Supply Chain Management)

Personal Details:

IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please mention N/A wherever not applicable

1. Name (in Block Letters): ......................................................................................................................................................

2. Date of Birth: M M D D Y Y Gender M F

3. Correspondence Address: ....................................................................................................................................................


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4. Permanent Address: .............................................................................................................................................................


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5. Telephone (Res.): Mobile:

6. Email: .....................................................................................................................................................................................

7. Nationality: ............................................................................................................................................................................

8. Occupation: ............................................................................................................................................................................

9. Name of the Company: .........................................................................................................................................................

10. Designation: .........................................................................................................................................................................

11. Employer’s Address: ...........................................................................................................................................................


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12. Telephone (Off.):


Educational Qualifications

Year of Passing
Stream/Degree %/Grade Board/University From To

Class X

Class XII

Graduation

Post Graduation

Any Other

Work Experience

Years of Experience
Name of the Organization Designation
From To

Licenses Obtained (if any) - Technical/Non-technical

Name Agency Validity

Your interest in joining UPES?

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Special Achievements

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How did you hear about us?

o
Website o
Newspaper o
Emailer o
SMS o
Magazine o
Any Other .......................................

Declaration
I hereby state that the information given above is true to the best of my knowledge. In case any information is found to be incorrect, my candidature is liable to be
cancelled by the University. I shall abide by the rules and regulations of the University of Petroleum and Energy Studies, including dress code, and expected
behavioral norms in line with the University’s special charter for the Oil & Gas Industry. I shall ensure timely payment of all applicable dues.

Date: / / 2 0 1 1 Student’s Signature


INFORMATION FORM FOR IDENTITY CARD

IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please fill in BLOCK LETTERS.

1. Name of the Program:

o
MBA (Oil & Gas Management)
o
MBA (Power Management) Affix
Photograph
o
MBA (Logistics & Supply Chain Management)

2. Duration of the Program: July 1, 2011 to June 30, 2014

3. Enrollment No. (For Office use only): E

4. Student’s Name (in English Capital Letters): .........................................................................


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5. Father’s Name: ......................................................................................................................................................................

6. Mother’s Name: .....................................................................................................................................................................

7. Correspondence Address: ....................................................................................................................................................


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8. Permanent Address: .............................................................................................................................................................


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9. Telephone (Res.): Mobile:

10. Telephone (Off.):

11. Emergency Contact No.:

12. Blood Group:

Authorized Signatory Specimen Signature of the Student


INSTRUCTIONS FOR SENDING THE ADMISSION FORM

MBA Program
Please send the filled in Admission Form along with:

1. Non-refundable Admission Form fees of `1,000/- (through demand draft) in favor of “UPES Fee Account”,
payable at Dehradun.

2. Xth & XIIth class certificates and mark sheets (photocopies should be self attested).

3. Graduation certificate & mark sheets (photocopies should be self attested).

4. Post graduation certificates & mark sheets (photocopies should be self attested).

5. Any other degree/diploma/certificate (as mentioned in the application form).

6. 2 passport size photographs.

7. Work experience certificate(s).

8. Completed ID form.

All these documents should reach us at the earliest at the following address:
Mr. Vikas Narula
Dy. Director (Marketing)
Centre for Continuing Education
vnarula@upes.ac.in

University of Petroleum & Energy Studies


Marketing Office
PHD Chamber of Commerce and Industry
PHD House, 4/2, Siri Institutional Area
August Kranti Marg
NEW DELHI – 110 016
Tel: +91-11-41730151-53
Fax: +91-11-41730154

www.cce.upes.ac.in