MBA APPLICATION 10600010

Preference 1. MBACU Preference 2.

Preference 3 .

Name. George Thomas Kallarackal ender. Male
e-mail. ranitomyhotmail.com Category. Kerala

Date of Birth.
24/10/1988
Place of Birth.
Kanjirapally
Nationality.
Indian
Religion.
Christianity
Catholic
Section.
General

/:cational Q:alification:
":alification. Board/Uni Instit:tion. State. Y/M of Pass Attmp
B.Com
Christ
University
Christ university Karnataka 81.22 2009, May
1
Class 10 CBSE
St Antony's
Public
Kerala 76.4 2004, May
1
Class 12 CBSE PLUS2
St Antony's
Public
Kerala 82.0 2006, May
1
Pre-requisite Exam:
MAT Composite: 672.5

Month.
Dec

Year.
2009

Roll No.
603490428


Parent Details:
Relationship. Name. Occ:pation. Income.
Father Tom K Varghese Lecturer 300000 - 400000
Mother Rani Tom 100000

C:rrent
Address
Maliakal House, , Kanjirapally, Kerala, India, 686507
Permanent
Address
Maliakal House, , Kanjirapally, Kerala, India, 686507

Phone N:mber. 91 04828 205926 Mobile N:mber. 91 9447409464

Declaration
II I eorge Thomas Kallarackal , do not have at least 85 oI attendance in each subject at the end oI each
Trimester and do not get at least the minimum pass mark oI the examinations conducted by the University as per
the norms laid down by the University, and iI I do not keep up the ideals oI the University and my conduct is not
good and indulge in any behavior or act that may come under the deIinition oI ragging, the Vice Chancellor/the
Registrar/OIIice oI Admissions/Controller oI Examinations/Department has the right to detain me or terminate
my admission at any time during my study. I also conIirm that the Iacts Iurnished in the application Iorm are true
to the best oI my knowledge and belieI.
Further, I promise to abide by the rules and regulations oI the University.


Date. Parents Signat:re. Candidates Signat:re.




Dear George Thomas Kallarackal , thank you Ior your interest in Christ University. Your
application 10600010 has now been submitted Ior review and once we receive all the
supporting documents we will Iollow up with an email shortly.In the meantime, please Ieel
Iree to visit www.christuniversity.in Ior answers to any questions you may have about the
program or the admission/application process.
Confirmation mail has been sent to ranitomyhotmail.com
READ ALL INSTRUCTIONS CAREFULLY
Kindly take a print out oI this application Iorm and send aIter pasting a recent passport size (3.5 cm width. x 4.5
cm length) photograph in the space provided Ior photograph. Send the Iollowing supporting documents in an A4
size envelope only

1. One Copy oI the SBI Application Fee Challan.
2. 2 passport size (3.5 cm width. x 4.5 cm length ) and 2 Stamp Size photographs. (Enter your name and application
number behind the photographs)
3. The Iilled-in printed application Iorm duly signed by the parent/guardian and the candidate
4. Copy oI Statement oI marks oI Class 10, Class 12 and Degree (Available)
5. Copy oI TransIer CertiIicates Irom last qualiIied Institution, Provisional and Degree CertiIicates (available)
6. Copy oI Statement oI marks oI Entrance Test `09 (Dec MAT 09/CAT 09)
7. Copy oI Migration CertiIicates Ior candidates Irom outside Karnataka (II available)
8. Copy Passport and Visa Page (II available) iI Irom Outside India

To:
PO Box No 2920, Hos:r Roa/, Bangalore . 560029

Or
Candidates sending the above documents by Courier Service should address the same to:
%e Office of Admissions, Crist University,
Hosur Road, Bangalore - 5 29

Candidates must mark the application as MBA A/missions 2010 - 10600010` on the top leIt hand corner oI the
A4 size envelope to Iacilitate Iaster processing.

The above supporting documents should reach us within 7 days oI submitting the application, online on or
beIore January 29, 2010.

You can check your application status on the URL appstat.christuniversity.in

Cecklist for te Applicant
Tick the relevant box before yo: sen/ the application form Yes No
1. I have Iilled-in the correct inIormation
2. I am attaching Copy oI SBI application Iee challan
3. I have written my name, application number, on the back oI 2 photos which is enclosed
4. I have pasted a photo in the space provided on the application Iorm
5. I am attaching the copy oI statement oI marks card oI Class X Marks Card
6. I am attaching the copy oI statement oI marks card oI Class XII Marks Card
7. I am attaching the copy oI my available Degree Marks Cards (SpeciIy number)
8. I am attaching the copy oI my TransIer (TC)/Migration CertiIicate
9. My Parent/Guardian and I have signed the declaration on the printed application Iorm.
10. I have read the statement oI undertaking and instructions regarding the Admission and Application process

Date:
Place:
Candidate`s Signature