SHRIRAM INSTITUTE
OF MANAGEMENT & TECHNOLOGY
Accredited ‘B(Good)’ (Edu) by NAAC
Approved by AICTE & NCTE Min. Of HRD, Govt. Of Uttarakhand
Affiliated to Uttarakhand Technical University, Dehradun & Kumaun University, Nainital
APPLICATION FORM
Gateway
to A
Bright Career.....
.....Building Values
Shriram Institute of Management & Technology
(A unit of Social Welfare & Education Society)
7th km Stone, Ramnagar Road, Kashipur - 244713 (Uttarakhand)
Academic Interests Application Number
Choice of Course (Please tick one)
Master of Business Administration (MBA)
Bachelor of Business Administration (BBA)
Bachelor of Commerce with Honours (BCom Hons)
Bachelor in Computer Applications (BCA)
Bachelor of Education (BEd)
Instructions
1. Applicants are requested to carefully go through the conditions mentioned in the prospectus before they
fill in their applications.
2. The application for admission should be accompanied by a Demand Draft, A/c payee, in favour of
“Shriram Institute of Management & Technology” payable at Kashipur for an amount as per the
prescribed fees by SIMT.
3. Attach two copies of recent passport size coloured photographs of the candidate.
4. Attach copies of the mark sheets/ certificates, etc., wherever necessary; originals should not be attached
with application
5. Attach additional sheet/s, if the space provided for information is inadequate
Personal Details
Name _________________________________________________________________
(In capital letters) FIRST NAME MIDDLE NAME SURNAME
Gender Male Female Nationality _________________________
Date of Birth
D D M M Y Y Y Y
Father’s Name _________________________________________________________________
FIRST NAME MIDDLE NAME SURNAME
Mother’s Name _________________________________________________________________
FIRST NAME MIDDLE NAME SURNAME
Marital Status (Married/Unmarried) ______________________________________________________
If Married, Give Husband’s Name (In case of Female Candidate) ________________________________________
Father’s/Husband’s Occupation _________________________________________________________
Group/Category (Attach Caste Certificate) _______________________________________________________
Father’s/Guardian’s Mobile no. _______________________________________________________
Father’s/Guardian’s Signature _______________________________________________________
Any Criminal Record/Any Criminal case in Court? __________________________________________
Address for Correspondence ____________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
CITY PIN STATE COUNTRY
Phone/Mobile No. _______________________________ E-mail ______________________________
(Include area code)
Permanent Address ___________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
CITY PIN STATE COUNTRY
Phone/Mobile No. _______________________________ E-mail ______________________________
(Include area code)
Educational Qualifications
Level Course e.g., BSc/ Board/University Institution Year Aggregate
BCom/BBA, etc. From To %
th
10 Standard
12th Standard
Graduation
Post Graduation
Others
Awards and Honour (Attach Certificates)
___________________________________________________________________________________
___________________________________________________________________________________
Interest, Hobbies and Language Known (Attach Certificates)
___________________________________________________________________________________
___________________________________________________________________________________
Application Fee Payment Details
Demand Draft No. ____________________________________ Dated __________________________
Drawn on Bank ____________________________________________________________________
Amount (r) ____________________________________________________________________
Details of Documents Attached
th th
10 Mark sheet & certificate 12 Mark sheet & certificate
Graduation Mark sheet & certificate Transfer certificate
Character certificate Caste Certificate
Domicile certificate Income certificate
Others certificates regarding co-curricular activities Bus Application Form
Affidavit required in case there is gap after last exam Book Bank Form
Affidavit required in case you passed last exam as private Insurance Form
Rules and Regulations
1. Misleading information or misrepresenting facts will disqualify the applicant from admission to SIMT
th th
2. Candidates must submit their 10 standard/ 12 standard/ Degree marks cards and certificates in original
at the time of admission. Admission may not be given in absence of these documents.
3. Payment of fees must be made by the prescribed date, failing which the admission will be forfeited.
4. Application / tuition fee is not refundable or transferable under any circumstances.
5. Candidates appearing for the qualifying exams must submit their proof of passing the qualifying exam
within 3 months of starting of the session.
6. The candidates must fulfill all the academic requirements notified by the authorities from time to time.
7. SIMT has full discretionary powers to alter the admission process, Code of Conduct, Rules &
Regulations without prior notice and without assigning any reason.
Declaration
I certify that all the information furnished above is complete and correct to the best of my knowledge. I agree to abide by
all rules and regulations that are in force time to time in the Institute. I understand that withholding or giving false information
will make me ineligible for admission. I also understand that the application fee and tuition fee paid to SIMT are not refundable
under any circumstances. Further, I have read and understood all the Rules & Regulations for admission to courses in SIMT. I
undertake that I will strictly follow the Code of Conduct, Rules & Regulations issued by the Management/K.U./Authorized body.
Signature of the Applicant
I certify that the aforesaid is true and if found false, I shall be held responsible for it.
Date: Signature of Father's/Guardian
For Office Use Only (Application)
Application received on _________________________
Receipt No. ________________________ Registration No. ________________________
Remarks _______________________________________________________________
_______________________________________________________________
Application Verified by ________________________ Date _________________________________
Signature of Fin. & Acc. Signature of Office Executive
For Office Use Only (Admission Details)
Application No. _______________________________________________________________
Receipt No. _______________________________________________________________
Course to which admitted _______________________________________________________________
Hostel _______________________________________________________________
Recommendation of the admission Committee ______________________________________________
___________________________________________________________________________________
Date Signature of Convener
CAMPUS: 7TH KM STONE, RAMNAGAR ROAD, KASHIPUR-244713, UTTARAKHAND
Ph: (05947) 223190, 223032, 9927010999 Email: simtrk@[Link], Web: [Link]
