PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE DETAILS

INSTRUCTIONS 1. Details are to be filled in BLOCK LETTERS and in the candidates own handwriting, neatly and legibly. The form should be complete in all respects. 2. Please do not enclose any original testimonials along with the form. 3. Please enclose attested copies of mark sheets, certificates of meritorious achievements and any certificates(s) for work experience. 4. All certificates and mark sheets (original) should be produced only at the time of interview. 5. Please provide the correct registration number of the test taken (CAT / MAT / XAT / GMAT / GRE), along with the email ID used for registration. In case of students taking MAT exam please provide both registration number and roll number. 6. Please send the completed application form to : Chairperson - Admissions Amrita School of Business Amrita Vishwa Vidyapeetham Amrita Nagar P.O., Ettimadai Coimbatore - 641 112 7. Superscribe on the envelope - Admissions 2012-14 8. Incomplete forms will result in rejection of your application.

VISHWA VIDYAPEETHAM
U N I V E R S I T Y

Amritanagar P.O., Ettimadai, Coimbatore - 641 112.

Amrita School of Business

Established under Section 3 of the UGC Act1956

Affix a Passport Size Photograph (Taken within the last 6 months)

MASTER OF BUSINESS ADMINISTRATION (MBA)

2012 - 2014 BATCH - APPLICATION FORM TO BE RECEIVED LA TEST BY FEBRUARY 11, 2012.
Form No. ...........................

Tick the appropriate box and provide the reigstration number, test date, score (if available) Refer to item #5 in instruction sheet.

TEST

CAT

MAT

XAT

GRE

GMAT

REGN NO Date & Score

Ahmadabad Bengaluru

Choice of ASB Centre for the Personal Interview (Please tick one) : Bhubaneshwar Chennai Coimbatore Hyderabad Kochi

Kolkata

Lucknow

Mumbai

New Delhi

A. A-1

PERSONAL DATA Name in BLOCK LETTERS (As per your UG certificate)

A-2 A-3

Age : Religion

Yrs.

Months

Date of Birth
D D M M Y Y

Sex :

M Single Married

_______________

Community / Caste

OC BC OBC MBC SC ST

Mother Tongue____________________ A-4 Address: (a) Permanent

Blood Group ________________

......................................................................................................................... ......................................................................................................................... ......................................................................................................................... Pin STD Tel

(b)

Mailing

......................................................................................................................... ......................................................................................................................... ......................................................................................................................... Pin e-mail : STD Cell No.

Contd...2

Tel

B B-1 B-2 C

FAMILYDETAILS Father's / Guardian's Name & Occupation Mothers Name & Occupation : :

PREFERENCE OF CAMPUSES - (Write 1-4 in the boxes, 1 indicating first choice)

Amritapuri

Bengaluru

Coimbatore

Kochi

Residential Status Preferred: Residential

D. D-1. ACADEMIC PERFORMANCE Education (Please enclose attested copies of all mark sheets and degree certificate received.) Stage Name of Year of No.of Branch/Major Examination Passing Attempts Specialisation Examining/ Certifying Authority Educational Institution
Percentage/

Day scholar

G.P.A.

Division

SSC/Equivalent

HSC/Equivalent

U.G. Degree I Yr.

U.G. Degree II Yr.

U.G. Degree III Yr.

U.G. Degree IV Yr.

P.G. Degree

Other qualifications (if any) (a) (b)

Contd...3

Students who are living with their parents in the city where the campus is located can avail this facility, if they are located within 30 km from campus.

D-2.

Please account for breaks in your academic career, if any.

D-3. Meritorious Achievements : Academic/Professional Awards/Medals/Prizes/Scholarship/Certificates/Honours, etc., (For co-curricular activities, use section F ) (Please enclose attested copies) No. 1 Name of Award Awarding Institution Level Basis of Award Year

E No.

WORK EXPERIENCE Please furnish a certificate from the last employer) ( Name of Orgn. Annual Size of Orgn. Turnover Category Designation (No.of (Rs. Lakhs) (F,A,O)* employees) Reporting to (Designation) Nature of duties Period From -To (in months) Total (monthly) Salary

*F : Full Time F No.

A : Apprenticeship/Vocational

O : Other (please specify)

MAJOR CO-CURRICULAR ACTIVITIES Activity Role Level Year From To Honours (if any) Remarks

Contd...4

PLEASE FURNISH TWO REFERENCES (SHOULD NOT BE CLOSE RELATIVES) ASB may contact the referees, if necessary. (1) ..................................................................... Name

(2)

Name

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

Occupation. ..................................................................... Address ..................................................................... ..................................................................... ` Pin

STD

Occupation. ..................................................................... Address ..................................................................... ..................................................................... ` Pin .....................................................................

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

Tel

STD

Tel e -mail :

e-mail :

REFLECTIVE ESSAYS (H TO J) USE ADDITIONAL SHEETS Write Reflective essays on the topics given below in about 400 words for each question: H I J K How will you introduce yourself to your classmates when you join the MBA class of 2012 at ASB? What are your career objectives and what do you need to learn at ASB to accomplish them? Tell us about a mistake you made in your life and what you learned from that experience? How did you come to know of ASB? CAT Coaching Centres : IMS T.I.M.E. Indian Express AIMA Friends Amrita PT Education Times of India IIMs Career Launcher Other (Please specify) The Hindu MBA Universe Relatives Telegraph PagalGuy Other _____

Newspaper : Hindustan Times Internet : Cool avenues.com Alumni Amrita University

M.A. MATH

Other (Please specify)

DECLARATION: All entries made in the application form are true to the best of my knowledge and belief. I am willing to produce original certificates on demand at any time. I also undertake that I shall abide by the rules and regulations of ASB and the University.
Place : Date :

Signature of the Applicant

UNDERTAKING: I .............................................................................. father/mother/guardian of................................................................................do hereby accept responsibility for good conduct of my son/daughter/ward during the entire period of the course, both inside and outside the campus. Signature of Parent/Guardian
Place : Date :