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1 9
NATIONAL INSTITUTE OF BANK MANAGEMENTNIBM Post Office, Kondhwe
Khurd, Pune 411 048
Tel :020-26716000 (EPABX) Fax : 020-26834478 e-mail :
[email protected]
Website : www.nibmindia.org
APPLICATION FORM
POST GRADUATE DIPLOMA IN MANAGEMENT (BANKING & FINANCIAL
SERVICES)
(Session Beginning 2014)
AICTE Recognized
Please read the instructions (given on the back of this form)
carefully before filling-up this application form.
Affix
Photograph of
4 cms x 3.5 cms
A. Personal Information
First Name (Mr/Ms.)
Middle Name
Last Name
Date of Birth
DD MM YY
Please tick mark () Female Male Married Single
Please tick mark () Whether you belong to SC/ST/OBC/Others
SC ST OBC Others
Father s Name :
Occupation :
Telephone No. :
E-mail :
Mobile No. :
Mailing Address
House No./Area/
Locality/Street/
City
State
Pin Code
STD Code & Tel. No.
E-mail
Mobile Alternate E-mail
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E. Academic Qualifications
Qualification Name of the Institution/ Name of the Year of Marks
(%)/CGPAProfessional Body State/UT Board/ Completion*
(max/obtained)
University
SecondarySchool (X)
Sr. Secondary
School (XII)
Graduate
Degree with Stream
B. Qualifying Examinations
As it appears in your CAT voucher/ATMA registration form/CMAT
voucher
Examination Registration No. Percentile/Score/Rank Valid Till
mm/yy
CAT 2013
ATMA (Feb. 16, 2014 only)
CMAT 2014-15
(Please attach a photo copy of the admit card of CAT/ATMA/CMAT.
Score card may be enclosed if result is declared)
C. NEFT/Demand Draft Details
Remitters Name: UTR No. Date of Remittance
(Please attach scan copy of the NEFT).
Name of the Bank DD No. DD Date
D. Preferred PGPBF Interview Centres,
viz.Pune/Mumbai/Delhi/Kolkata/Bengaluru/Lucknow
(Centres other than Pune are tentative)
First Preference
Second Preference
* (Please mention final year of completion only. Otherwise write
appearing)
Post-Graduate
Degree with Stream
Professional 1.
Degrees/ 2.
Diploma/ 3.
Certificate 4.
Marks (%)/CGPA Marks (%)/CGPA(max/obtained) (max/obtained)
Semester 1
Semester 2
Semester 3
Semester 4
Semester 5
Semester 6
Semester 7
Semester 8
Semester 1
Semester 2
Semester 3
Semester 4
Marks (%)/CGPA Marks (%)/CGPA(max/obtained) (max/obtained)
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I. Declaration
All entries made in this application form are true to the best
of my knowledge and belief. I am willing to
produce original certificates in support thereof if asked to do
so at any stage. Admission can be cancelled at
any stage, if any information given is found to be
incorrect.
Place ______________________________
Date _______________________________
G. Academic/Professional
Awards/Medals/Prizes/Scholarships/Certificates/Honours, etc
(Excluding those for extra-curricular activities)
Name of the Award Awarding Institution Level Basis of Award
Year
H. Major Extra-Curricular Activities/Hobbies at
School/College/University
Activity Role LevelYear
Honours, if any RemarksFrom To
1.
2.
3.
4.
(Please see overleaf for Instructions for Filling the
Application Form)
Signature
F. Work Experience [Furnish details of jobs starting with
latest/current job first]
Organization Designation Nature of Designation of Experience
Name Duties Last Person in Years &
Reporting to Months
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Instructions for Filling the Application Form
(a) Fill in the application form in CAPITAL letters with pen.
Complete all items relevant to you. Incomplete
applications will be rejected. Any mistakes and/or loss on
account of wrong and/or illegible entries are
the sole responsibility of the applicant.
(b) Mention your name (as it appears in the CAT/ATMA/CMAT
voucher) and CAT/ATMA/CMAT
Registration number in the NIBM Application Form.
(c) Please paste your photograph in the appropriate space
provided, do not staple it.
(d) CAT/ATMA/CMAT applicant should make sure to enclose a photo
copy of the CAT/ATMA/CMAT
admit card with this application form.
(e) Candidates appearing for the final year bachelors
degree/equivalent qualification examination and those
who have completed degree requirement and are awaiting results
must attach photocopy of the certificate
from the Principal/Head of the Department/Registrar/Director of
the University/Institution certifying
that the candidate is currently in the final year/is awaiting
final results and has obtained at least 50%
marks or equivalent based on the latest available grades/marks.
If admitted, admission of such candidates
will be provisional and subject to their completion of all the
eligibility requirements of the Programme
mentioned in the prospectus.
(f) Please do not enclose any testimonials along with the form.
All certificates (original) should be producedat the time of the
interview.
(g) The filled-in application form should be accompanied with a
payment of Rs 1250. The amount may
preferably be transferred by RTGS/NEFT/ECS to our A/c No.
20002403044 with Bank of Maharashtra,
NIBM branch, Pune (IFSC Code MAHB0001124).For all electronic
remittances, kindly send a confirmatory
e-mail at: [email protected] giving details of the remitters
name, UTR No., date of remittance and
scan copy of the NEFT. In case, the amount is remitted by demand
draft,it should be made in favour of
'National Institute of Bank Management',drawn on any Bank and
payable at Pune. The remittence and
the filled-in application form should reach The Dean (E) &
Principal of the Institutebefore February 15,
2014. A copy of the Prospectus will be sent subsequently.
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