8/7/2019 IEMR_PGPM 2011-13_Application Form

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 Application No: IEMR/PGPM/1113/__________ (Official use only)

Institute of Energy Management and Research

Application Form for Post Graduate Program in Management 2011-13  Affix Passport 

Size Photo

1. Name

2. Father's Name

3. Date of Birth (DD/MM/YYYY)

5. Nationality

6. Mailing Address

Pin

7. Tel No. (Landline) (with STD code)

(Mobile)

8. Email ID

9. Academic Record

Post- Graduation (if any)

**

Qualification Degree Discipline* School/College Board/University Year % /CGPA

143-144, Udyog Vihar, Phase IV, Gurgaon 122 015, Haryana, INDIA

Affix Photo

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Higher Secondary (XII)

Secondary (X)

* Branch of Engineering/Science/Commerce/Arts/Other 

** If appearing in current session, please write the cumulative grades excluding final semester 

10. Work Experience

To

11. Aptitude Test Results

CAT

MAT

XAT

GMAT

Have not given any of the above tests but willing to appear for IEMR Aptitude Test (please tick the the box on the right)

Test Name Composite/Total Score Composite/Total Percentile Date Taken

Organization Designation Nature of WorkDuration

From

8/7/2019 IEMR_PGPM 2011-13_Application Form

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(page 2)

Application Form for Post Graduate Program in Management 2011-13

12. Special Achievements

a. Academic Honors 1.

2.

b. Extracurriculars 1.

2.

c. Others (please specify)

13. Choice of City for Personality Bangalore Chennai Delhi

Assessment (Tick only one box) Hyderabad Kolkata Mumbai

14. Application Fee Payment if by Demand Draft

Details (Rs.1000 Only) DD No: __________________________ Bank____________________________________ Date________________

if by Electronic Transfer

Transaction No: __________________ Bank____________________________________ Date________________

Declaration: I certify that the information provided in this application is correct.

Place :__________________________________ Applicant’s Signature :___________________________________

Date : __________________________________ Applicant’s Name :___________________________________

Instructions to fill up the application form

1. Write in block capital letters using black ink in the boxes provided.

2. Provide all the information required. Incomplete applications may be rejected.

3. Affix your passport size photograph in the space provided with your signature across the photograph.

4. Attach a copy of your CAT/MAT/XAT/GMAT score card.

payable in New Delhi.

7. Indicate the demand draft number, bank name and date in the space provided in the application form.

8. In case of any queries please write to admissions@iemr.in or call +91 124 4780010

9. Completed application form along with all the attachments may be couriered, posted or hand-delivered to:Admissions Office

Institute of Energy Management and Research

143-144, Udyog Vihar, Phase IV

Gurgaon 122 015, INDIA

Ph: +91 124 4780010

Fax: +91 124 478000

in taking the IEMR Aptitude Test. Shortlisted applicants would be informed about the time and venue for the same.

6. Enclose a non-refundable demand draft for Rs. 1000 drawn on “Institute of Energy Management and Research” and

5. Student who have not taken any of the listed Aptitude Tests can submit their application form indicating their interest