Sl.No.

: ______

INDIAN MARITIME UNIVERSITY

(A Central University, Govt. of India)
East Coast Road, Uthandi, Chennai - 600 119

APPLICATION FORM FOR MBA 2011-12

Please select ( √ ) your programme

Passport Size
Photograph
M.B.A in Port and Shipping Management

M.B.A in International Transportation and Logistics Management

1. Name of the candidate (in capital letters)

2. Father’s name_______________________________ Mother’s name__________________________________

3. a) Date of Birth (b) Age (c) Nationality

D D M M Y Y
(as on 01.07.11)

(d) Gender e) Marital Status f) SC/ST /OBC/OC

4. Permanent Address

Name

Door.No.

Street

City

State

PIN

Telephone No. ______________________________ Mobile No. __________________________________________

E-mail: _________________________________________________________________________________________
5. Details of academic record

NAME NAME MONTH RESULT

EXAMINATION OF THE OF THE &YEAR
PASSED UNIVERSITY/ GROUP/ Of MAX MARKS CLASS/
PERCENTAGE
BOARD DEGREE PASSING MARKS OBTAINED DIVISION

Matric / SSLC.

Inter / HSC.(10+2)

Bachelor’s Degree

6. Employment details, if any

EMPLOYER’S DETAILS POSITION HELD DUTIES AND RESPONSIBILITIES PERIOD

7. Achievements in Sports & Cultural activities:

(Attach certificate(s) in support of your claim). Please tick ( √ ) in the relevant box.

Field of activity ………………………………

STATE LEVEL NATIONAL LEVEL

8. Whether you were subjected to a disciplinary action by any authority? YES /NO

If yes, give details

9. Payment Details

NAME OF THE BANK DD NUMBER DATE OF ISSUE AMOUNT (Rs.)

10. Declaration by the applicant:

I hereby declare that the information furnished by me in the application and other documents attached to the
application are true, complete and correct. In case, any information in this application or any document attached
thereon is found to be false or incorrect at any time (during or after completion of the course) this shall entail
automatic cancellation of my admission, if granted, cancellation of the Degree if awarded besides rendering me
liable in such action as the university may deem it fit.

I agree that the fees once paid shall not be claimed by me under any circumstances.

Further, in the event of any medical or other emergency, my Parents or Guardian may be contacted at the address
given therein.

Place:______

Date:______ Signature of Candidate

11. Declaration by the parents / guardian:

My Son /Daughter/Ward --------------------------------------------- is applying for admission to the University, in case
of his or her admission to the University, I shall be responsible for payment of all his/her fees and other charges
including any emergency, medical or other expenses incurred by the University. In case of any information in this
application found to be false or incorrect at any time (during or after completion of the course), it shall entail
automatic cancellation of my son’s/daughter’s/ward’s admission, if granted, cancellation of the degree if awarded
besides rendering him /her liable to such action as the University may deem it fit. I will also be responsible for his/
her good conduct and behaviour during the period of his/her stay in the University. Further, I may be contacted in
the event of any emergency as determined by the University and I hereby promise I will present myself before the
university authority at my own cost whenever the University requires my presence.

Signature of the Parent/Guardian

Place:_______________ Name ______________________________________

Date:_______________ Relationship with the applicant __________________

Telephone / Mobile number:

(Office):_____________________________

(Residence): ________________________

Note: Signature of the Parent in this application will be considered as basis of all verification purpose in the University.
 Address for Communication Address for Communication

PIN PIN

Tel. No. ……................………...................................… Tel. No. ……................………...................................…

Mobile No. ……................……….................................. Mobile No. ……................………..................................

E-mail: ……………………………………………….... E-mail: ………………………………………………....

GENERAL INSTRUCTIONS

1. Read the instructions sheet carefully before filling the application form.
2. Incomplete application will be summarily rejected. If it is found that any information furnished in the application is
false or incorrect at any time, the provisional admission, if granted, shall automatically stand cancelled.

3. Prospectus and Application form can be directly obtained from the University for a fee of Rs. 1000/-, for General/
OBC, and Rs. 500/- for SC/ST/PC, through Demand Draft. It can also be downloaded from www.imu.tn.nic.in /
www.imusmm.com

4. The filled in application form with the following documents should be sent to the University.
a. Demand Draft for Rs. 1000/-, for General / OBC and Rs. 500/- for SC/ST/DA candidates (for downloaded application
only) drawn in favour of “INDIAN MARITIME UNIVERSITY”, payable at ‘CHENNAI’. The name and the address of the
candidate and the name of the programme should be written on the reverse side of the Demand Draft.

b. An attested copy of the SSLC certificate (for age proof).

c. An attested copy of the degree certificate and academic transcripts.
d. An attested copy of the Community certificate, if applicable.

5. The filled in application form should reach the University on or before April 8, 2011.

The Admission Coordinator - MBA 2011,

Academic Section, Indian Maritime University,
East Coast Road, Uthandi, Chennai – 600119.

6. Admission will be based on the candidate’s academic performance, CET score, Group Discussion and Personal
Interview.

7. Reservations will be followed as per the Government of India norms.

REGISTRAR