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Appl. No.:
CHECK SLIP
(Columns 1 & 2 to be filled up by the candidate)
School of Business and Management Science
(Founder, Alhaj. Dr. B.S. ABDUR RAHMAN)
Accredited by The National Board of Accreditation
An ISO 9001 - 2000 certified Institution. Affix Passport Size Photo
1. Name and Address : .......................................................................
Seethakathi Estate, G.S.T. Road, Vandalur, Chennai - 600 048. India.
Phone : 044 - 22751347, 22751348, 22751350, 22751375, 22750007
Fax : 044 - 22750520, Email : [email protected]
.......................................................................
www.bsauniv.ac.in, www.crescentcollege.org

....................................................................... APPLICATION FOR ADMISSION TO

MBA DEGREE COURSE 2009
st
2. Age as on 1 July : .......................................................................
1. Read all the Instructions carefully before filling in the application form.
2. Mark in the appropriate box wherever applicable
3. The candidate should ensure that marks, age and community are furnished correctly by him/her in the application form.
4. The candidate is informed that if after scrutiny it is found that the particulars furnished by him/her in the application form are not correct, then
FOR OFFICE USE ONLY (i) he/she will forfeit the admission, no matter at what stage of the course he/she will be in, at that time
(ii) he/she is liable to be debarred from pursuing any course of study for a period of three years.
(iii) legal action will be instituted against him/her for furnishing wrong particulars.

4. Qualifying examination : Degree (Branch) ............................................. 1. Name (in block letters with initials at the end) _________________________________________________

Year of passing ............................................. Address for Communication ____________________________________________________________

......................... % Class ____________________________________________________________

Telephone No with STD Code : ___________________________ Pincode

5. Community : ST SC MBC/DNC BC(Muslims) BC Others
Mobile No: ___________________________
6. Application form complete : Yes No
E-Mail: ____________________________________________________________
7. Particulars verified by : Name ..................................... Signature ........................
2. Sex: Male Female
8. Originals Verified by : Name ..................................... Signature ........................ Age as on 1st July
3. (i) Date of Birth & Age Date of Birth (Christian Era)
Month Day Year Years Months Days
9. Countersigned by : Name ..................................... Signature ........................

10. Reasons in case of rejection : ..................................................................................

(ii) Place of Birth __________________ ______________________ _______________
......................................................................................... Village/town/city District State

Name ..................................... Signature ..................... 4. Qualifying Examination: (Enclose attested copies of mark sheets. At the time of admission the original certificate
should be submitted)

(i) Name of the Degree (with Branch): (ii) Duration of the Course :

Please State whether the course was Full Time Part Time Correspondence/Distance Education

Countersigned by (iii) College and University: (iv) Month & Year of passing:
Registrar
(v) Percentage of marks: (vi) Class Obtained:
(Candidates in the final year to furnish Percentage of marks up to Previous Semester.)
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5. a) Community : ST SC MBC/DNC BC (Muslim) BC OC 15. Details of the Qualifying Examination.

b) Name of Caste :(In case of BC/MBC/DNC/SC/ST Only) ........................................................................... Semester / Year No of subjects % of marks No of arrears
c) Religion Muslim Others I ........................ ..................
Specify II ........................ .................. .....................
6. Are you a citizen of India? Yes No
III ........................ .................. .....................
7. Mother Tongue ....................................................................................
IV ........................ .................. .....................
8. i) Name of Father ....................................................................................
V ........................ .................. .....................
ii) Name of Mother ....................................................................................
VI ........................ .................. .....................
iii) Residential Address of parent/guardian
for communication .................................................................................... VII ........................ .................. .....................

.................................................................................... VIII ........................ .................. .....................

iv) Name of Guardian (if applicable) .................................................................................... 16. Details of Entrance Exam

v) Telephone Number / Mobile No: .................................................................................... MAT SCORE................................ . Reg No..................... Date............................

Others........................................ Reg No..................... Date............................

9. i) Occupation of the parent / guardian
with designation, ....................................................................................

ii) Department / office address : .................................................................................... 17. State in a separate sheet your reasons for joining the MBA programme in about 300 words.
.................................................................................... I declare that the information furnished are correct to the best of my knowledge.
iii) Telephone Number : ....................................................................................
I confirm that I have read the instruction No.3 and 4 on the first page of this application and assure to abide by the same.
10. Annual income of parent / guardian (Rs.) ....................................................................................

11. Do you require hostel accomadation ? If yes, Give the address of local guardian ........................................
Place : ..............................................
....................................................................................

12. Extra Curricular activities .................................................................................... Date : ...............................................

Signature of the Applicant

Yes No If yes Event Yes No
(a) Sports ................... (d) N.S.S.

(b) Games ................... (e) Other extra curricular activities (State)

(c) N.C.C.

13. Proficiency in sports and games : Represented : Nation State Dist. Not applicable

14. Academic Performance :

Course Institution with address University / Board % of marks Year of passing

10 th Std ........................ ........................ ........................ ........................

12 th Std ........................ ........................ ........................ ........................

Degree ........................ ........................ ........................ ........................

........................ ........................ ........................ ........................ ........................