PGDM Application Form

Application No: ENQ2025PGDMN0878

Basic Details
Personal Details
Title MR First Name RISHABH Middle Name
Last Name PATEL Email Address [email protected] Mobile Number +91-9569029175
Date of Birth 10/03/2002 Gender MALE Category OBC
Aadhaar Card Physically Household Income (
383182733184 NO 1000000
Number Handicapped? Per Annum)
Source of
Information about SACHIN SIR ONLINE
IMS

Address Details
Address for Correspondence
Country INDIA State UTTAR PRADESH District JALAUN
City JALAUN Address Line 1 10,KHERA KALAN SOMAI JALAUN Address Line 2
Is Permanent Address
Pincode 285201 Same As Address For YES
Correspondence?
Permanent Address
Country INDIA State UTTAR PRADESH District JALAUN
City JALAUN Address Line 1 10,KHERA KALAN SOMAI JALAUN Address Line 2
Hostel
Pincode 285201 Accommodation NO
Required

Educational Qualification Details

Educational Qualification
10th Qualification Details

Course / Year of Institution Marking Maximum Marks Obtained

Board/University
Stream Passing /College Scheme Marks Obtained Percentage/CGPA
U.P. BOARD OF HIGH
CHILDRENS CARE
10th SCIENCE 2018 SCHOOL AND INTERMEDIATE PERCENTAGE 600 476 79.33
H S SCHOOL
EDUCATION

12th Qualification Details

Course / Year of Institution Marking Maximum Marks Obtained

Board/University
Stream Passing /College Scheme Marks Obtained CGPA/Percentage
U.P. BOARD OF HIGH JAI NARAYAN VIDYA
12th SCIENCE 2020 SCHOOL AND MANDIR INTER PERCENTAGE 500 380 76.00
INTERMEDIATE EDUCATION COLLEGE

UG Result Status DECLARED

Graduation Details

Course / Year of Marking Maximum Marks Obtained

Board/University Institution /College
Stream Passing Scheme Marks Obtained Percentage/CGPA
BUNDELKHAND PT. GHANARAM
BACHELOR OF
UG 2023 UNIVERSITY, UTTAR HARIRAM PERCENTAGE 900 625 69.44
ARTS
PRADESH MAHAVIDYALAYA

Entrance Exam Details

Have you given
any entrance YES
exam?
Exam Details New

Exam Name Batch Roll No Result Status Percentile Score

1 CAT 11/2024 24048365 DECLARED 31.44 12
2
3
4
5
6
7

Work Experience Details

Do you Have any
NO
work experience?
Work Experience Details

Company Name Industry From To Total Experience (Months)

1

Total Experience

Parent Details
Father's Details
Father's Email
Father's Title MR Father's Name SHYAM KARAN PATEL [email protected]
Address
Father's Mobile Father's Aadhaar Father's
+91-8303953659 732797713819 SELF EMPLOYED
Number Card Number Occupation
Father's
Designation
Mother's Details
Mother's Email
Mother's Title MRS Mother's Name KALPANA PATEL [email protected]
Address
Mother's Mobile Mother's Aadhaar Mother's
+91-9721817522 814382291852 SELF EMPLOYED
Number Card Number Occupation
Mother's
Designation

Upload Documents
Upload Documents

Upload Your Recent

Upload Your 10th Upload Your 12th
Passport Size YES YES
Marksheets : Marksheets :
Photograph :

Upload Your
Upload 12th Admit Upload Graduation
NO YES Graduation YES
Card : Certificate :
Marksheets :

Upload Student Upload Candidate Upload Specimen

YES YES YES
Aadhaar Card : Parent’s Aadhar card : Signature :

Upload Qualifying Transfer Certificate

NO NO
Exam Scorecard : (Under Graduation) :

Declaration
1. THE REGISTRATION IN THE SWISS IMMERSION PROGRAM WILL BE DONE ON A FIRST COME FIRST SERVE BASIS.
2. THE INITIAL REGISTRATION FEE TO ENROLL FOR THE SWISS IMMERSION PROGRAM IS RS. 15000 WHICH IS REQUIRED TO BE SUBMITTED AT THE TIME OF REGISTRATION OF ADMISSION.
3. THE ABOVE REGISTRATION AMOUNT IS NON-REFUNDABLE.

Declaration
DECLARATION BY STUDENT
1. I HEREBY CERTIFY THAT THE PARTICULARS FURNISHED BY ME IN THE APPLICATION FORM ARE CORRECT.
2. I UNDERTAKE THAT I WILL NOT ASSOCIATE/INVOLVE MYSELF IN ANY UNLAWFUL ACTIVITY.
3. I UNDERTAKE THAT I WILL NEITHER SMOKE NOR CONSUME ALCOHOL. DRUGS OR ANY OTHER INTOXICANT, WITHIN INSTITUTE/ HOSTEL PREMISES.
4. I CERTIFY THAT I HAVE NEVER BEEN DEBARRED FROM APPEARING IN ANY EXAMINATION.
5. I ALSO DECLARE THAT NO POLICE INQUIRY IS PENDING AGAINST ME.
6. I FULLY UNDERSTAND AND UNDERTAKE THAT I WILL ATTEND ALL CLASSES AS PER INSTITUTE TIME TABLE. I ALSO UNDERSTAND THAT I WILL NOT BE ALLOWED TO APPEAR IN EXAM, INCASE MY
ATTENDANCE FALLS BELOW 80% LEVEL.
7. I UNDERTAKE THAT I WILL SUBMIT MY FINAL RESULT BEFORE LAST DATE OF ADMISSION FAILING WHICH I WILL HAVE NO CLAIM WHATSOEVER AND THE INSTITUTE MAY CANCEL MY ADMISSION.
8. I ALSO CLEARLY UNDERSTAND THAT IF I AM FOUND TO BE DIRECTLY/INDIRECTLY INVOLVED IN ANY CASE OF RAGGING AT ANY STAGE OF MY STAY IN THE INSTITUTE/HOSTEL, THE INSTITUTE
WILL HAVE THE RIGHT TO EXPEL ME FROM THE INSTITUTE AND THE HOSTEL AND REGISTER A CRIMINAL CASE AGAINST ME, AS PER THE DIRECTION OF HONOURABLE SUPREME COURT OF INDIA.
9. IN CASE OF DISPUTE, THE DECISION OF DIRECTOR SHALL BE FINAL AND BINDING.
10. I HAVE READ AND UNDERSTOOD THE RULES OF DISCIPLINE OF THE INSTITUTE AND SHALL ABIDE BY THEM. I ALSO FULLY UNDERSTAND THAT IN CASE OF ANY VIOLATION, I CAN BE DETAINED
IN THE TRIMESTER, RUSTICATED, OR EXPELLED FROM THE INSTITUTE.

Applicant Name RISHABH PATEL Parent Name SHYAM KARAN PATEL Date 13/01/2025