Please take a printout of the form and fill up the details.

Admission Form

Form No. I __ __ __ __ __
Downloaded from Website

INDIAN INSTITUTE OF SOCIAL WELFARE AND BUSINESS MANAGEMENT
MANAGEMENT HOUSE, COLLEGE SQUARE WEST, CALCUTTA – 700 073

Application for the admission in: MBA(D) / MBA(E) / MHRM / MPSM* / PGDBM / PGDRM

( * For MPSM Programme please indicate your course priority number ( 1 / 2 / 3 / 4 ) in the corresponding blank box below )

MPSM (Environment)   MPSM (Energy)  
MPSM (Transportation & Logistics)   MPSM (Health Care & Hospital Management)  
    
1. Name :MR./MISS/MRS. _________________ _________________ _________________
    (IN CAPITAL LETTER) FIRST NAME MIDDLE NAME SURNAME

   
2. Father’s/Husband’s Name : __________________________Mother's Name :_________________

3. Date of Birth:
    (ddmmyy)		      
4. Sex
Male Female
5. Whether Physically Handicapped :
Yes No

6. Do you belong to Scheduled Caste/Scheduled Tribe (Tick in the appropriate box)

   SC
 ST
 GEN
Affix a recent
Passport size
coloured
Photograph

7. Permanent Address:_______________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

8. Present Address:_________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

9. Telephone: Residence:____________________________Office:____________________________

10. Name Code : (First ten Letters of Name)

                   

11.(For MBA(D) /MBA(E) / MHRM / MPSM / PGDBM/PGDRM  Courses only as applicable)

a. CAT/MAT Registration No.
   
  b. CAT/MAT Centre Code
   
c. CAT/MAT Score & Percentile
   

12. Academic Qualifications (Secondary Onwards)

Examination

Board/ University (Also Name of School/College)

 Year Main Subjects (Specify Honours) Marks Obtained % of Marks Class/Div.
  

 

                   
     

 

               
     

 

               
     

 

               
     

 

               

13. Any other Qualification/Extra-Curricular Activities: _______________________________________
____________________________________________________________________________________
____________________________________________________________________________________

14. Work Experience : Yes
   
No
   

15. Work Experience Details ( Please attach extra sheets if necessary ):

Organisation
Name & Address		 Designation Department Salary per
Month		 Period of
Service		 Short Description
of the Job
                       

16. Person reporting to (in current organisation): __________________________________

17. (For MBA (Even) / PGDBM Programmes)

     Signature of the Sponsor:____________________________________________

  

     Office Seal & Date : ________________________________________________

18. Signature of the Applicant: ___________________________________________

19. Email of the Applicant (mandatory): ____________________________________

20. Date of Application: ________________________________

21. Demand Draft No.___________      Amount___________    Bank___________
     (No form will be entertained if not accompanied with a demand draft)