D. Y. PATIL UNIVERSITY, NAVI MUMBAI · 2. MBA in Retail Management 3. MBA in Health & Hospital Management 1. MBA in Core Program 5. MBA in Biotechnology Management 6. MBA in Pharmaceutical

APPLICATION FORM FOR THE MASTERS IN BUSINESS ADMINISTRATION (MBA)

(2 Years full time MBA program-Core & Sectoral Programs)Application No:

Preference given to the programs

D. Y. PATIL UNIVERSITY, NAVI MUMBAI(Established under section 3 of the UGC Act, 1956 (NAAC Re-Accredited ‘A’)

‘Dnyanpushpa Niketan’ , Plot No. 10, Sector - 4, C.B.D Belapur, Navi Mumbai 400 614 Tel.: +91 22 2758 9200 www.dypusm.com

12th by Higher Education Review. “Beyond IIMS”, April 2014, Ranked A++ by Business India, Nov.2013Ranked amongst Top100 B-Schools in India by Dalal street Journal, Nov 2011

Amongst the Top 10 % of Indian Universities

(Ranked 65th by Times Neilsen Survey, March 2014) SCHOOL OF MANAGEMENT

2. MBA in Retail Management

3. MBA in Health & Hospital Management

1. MBA in Core Program

5. MBA in Biotechnology Management

6. MBA in Pharmaceutical Industry Management

4. MBA in International Business Management

8. MBA in Logistics and Supply Chain Management

9. MBA in Aviation Management

7. MBA in Banking & Insurance Management

1. Name in Block Letters: Students Name Surname

4. Gender: Male/ Female

6. Religion

5. Nationality: Indian/_________________________(Mention name of the country)

7. Sub Category : SC/ST/DT/NT1/NT2/NT3/SBC/OBC/VJ/OTHER/GEN

2. Date of Birth: 3. Place of Birth

8. Address for communication:

Tel No. + STD Code

Mobile Number

Email Id

9. Permanent Address :

Tel No. + STD Code

Parents Mobile Number

Parents Email Id

10. Educational Qualification (Student have to submit Orignal of College Leaving / Transfer Certificate, Graduation Marksheet & Passing Certificate) :

DegreeArts/Sci /Com/Engg.etc Year of Passing Name of the University % age marks Obtained

SSC

HSC

Degree

Post Graduation

Father’s Name Mother’s Name

Marks obtained in the All India Qualifying exam :

Or Marks obtained at the DYPCET Entrance Exam :

Marks obtained at GD :

Marks obtained at PI :

Additional Marks for Work Experience :

FOR OFFICE PURPOSES

Additional Marks for Sports Activity :

Total Marks : Admitted: Yes/ No

DirectorAdmin. HeadCo-ordinator of Admission

Remarks :

12. Name of the entrance examination undertaken: CAT MHCET CMAT

13. Year of taking the above exam: Score obtained at the above entrance exam:

14. Work Experience (If any):

Position Period of EmploymentGive in Brief the

Job responsibilitiesLast Salary drawn (Rs. per Month)

Name and Address of the Employer

15. Whether represented in sports at state/National level (Please Attach Certificate) : Yes No

11 .Last College Attended____________________________________________________________Roll No._____________________

Year of Passing _____________________________& University_____________________________________________________

DYPCETTick the appropriate box

UNDERTAKING1. Minimum 75% class attendance is necessary for all semesters. If my attendance is found to be unsatisfactory, I shall not be permitted to give the semester end examination. 2. I promise that I shall attend the classes regularly and appear for the entire internals and Examinations held by the college during the academic year.3. I hereby accept the College Policy that students who have serious complaints of indiscipline against them during the year will not be re-admitted to the College in future.

The decision of the Director, in this matter, will be final. 4. Students will not be granted terms unless,

a. They have attended at least 75% of the lectures in each semester;b. Their Projects / Assignments for semester work are certified by the department Concerned;

5. I have read and have fully understood the UCG Regulations on “Curbing the Menace of Ragging in Higher Educational Institutions, 2009” and the directions of the Supreme Court and the Central / State Government in this regard, as given in the prospectus. If found guilty of any aspect of ragging, I may he punished as per the provisions of the UGC Regulations mentioned above and / or as per the law in force. I also herby affirm that I have not been expelled or debarred from admission by any institution. I accept all the above conditions.

6. As per the refund policy No fees refund is possible after starting the lecturers.

Declaration by Student: I hereby declare that, I have read the rules related to admission and the information filled in by me this form is accurate and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form signed by me and I undertake that, in absence of any document the final admission will not be granted and or admission will stand cancel.

Place: __________________ Date: ______________ Signature of Student ____________________

Declaration by Parent: I have permitted my son / daughter to join your college. The information supplied by him / her is correct to the best of my knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter.

Place: __________________ Date: ______________ Signature of Parent____________________

ATTESTED COPY OF THE FOLLOWING DOCUMENTS:

2) HSC Mark sheet & Certificate

3) FY/SY/Graduation Result with passing Certificate & Degree Certificate

4) Transfer Certificate

5) Migration Certificate

6) Passport/Domicile Certificate

7) Valid Passport & Visa(for foreign national)

8) Birth Certificate / Leaving Certificate

9) Work Experience Certificate

10) Caste Certificate & Caste Validity Certificate

11) Entrance Score Card (CAT or MHCET or CMAT)

1) SSC Mark sheet & Certificate

12) Aadhar Card / Ration Card

DYPCET & G.D./ P. I. HALL TICKET (Full Time MBA)

Year - 2016 APPLICATION No

Student's Photo

Name of the Candidate:

Hall Ticket No:

Place of Exam : D. Y. Patil University School of Management

Dnyanpushpa Niketan, Sector -04, Plot No-10,

CBD Belapur , Navi Mumbai.

Date :

Supervisor's Signature Student's Signature






DYPCET & G.D./ P. I. HALL TICKET (Full Time MBA)

Year - 2016 APPLICATION No

Student's Photo

Name of the Candidate:

Hall Ticket No:

Place of Exam : D. Y. Patil University School of Management

Dnyanpushpa Niketan, Sector -04, Plot No-10,

CBD Belapur , Navi Mumbai.

Date :

Supervisor's Signature Student's Signature






Documents

D. Y. PATIL UNIVERSITY, NAVI MUMBAI · 2. MBA in Retail Management 3. MBA in Health & Hospital Management 1. MBA in Core Program 5. MBA in Biotechnology Management 6. MBA in Pharmaceutical