Shri Shivaji Education Society Amravati’s
DR.. PANJABRAO DESHMUKH INSTITUTE OF MANGEMENT TECHNOLOGY & RESEARCH
DNC, Nagpur -440 012
Application form for Admission to P.G. Programme.
To Do Not Staple
The Director Paste Your
Dr. Panjabrao Deshmukh Institute of Latest
Management Technology & Reasearch Passport Size
Nagpur - 12 Photograph
Here
Sir,
I hereby apply for admission to Course
(Write in Capitals only)
1) Name :-
(As per University Degree)
(Tick at appropriate Box only)
2)Sex : Male Female
3) Date of Birth :
Date Month Year
4) Nationality : Indian Other
5) Marital Status : Married Unmarried
6) Category : Open SC ST OBC NT Other (Specify)
7) a) Educational Qualification (Which makes you eligible for the programme)
Qualification
Year of Passing
Percentage of Marks
[Link] Science Engineering Arts Commerce Pharma
Graduate
Post Graduate
Specify-Specification
8) a) Name of Last Examination passed
Year
b)Name of University
c) Enrolment No:-
( If already enrolled with Nagpur University)
9) a. Employment Status :
Unemployed Employed Self- Employed
b. Work experience( if any)
Duration :- Year Month
Name of Organization :
Designation :
10) Annual Income of Parents :-
Upto to Rs. 2,00,000 2 lakh to 3 lakh Above Rs. 3 lakh
11) (a) Address for Correspondence : ( Do not write Father’s or your name here)
City :
State:
Pin code :
(b) Telephone no. (with STD code)
Mobile Phone (if any)
(c) E-mail address(if any)