APPLICATION FORM FOR MBA PROGRAMS

SESSION 2020-2022

It is mandatory for the applicant to keep a photocopy of the duly filled

Paste
application form before submission. Please ensure that you carry the a latest coloured
photocopy of this application form, two passport size photographs, original passport sized
copies and 2 photocopies of all the certificates attached, when you report photograph
for counselling. This application form has to be submitted at Admission &
Office, Chitkara University. attach two
additional copies
Please fill a number in the corresponding box in the order of MBA program preference thereof.
with 1 being the most preferred and 12 being the least preferred program.

Marketing Finance & Banking Business Analytics

Human Resource Supply Chain Management Rural Management

Healthcare Management Healthcare IT Public Health (MPH)

Retail Management Pharmaceutical Management BFSI

1 Student’s Name ( Kindly write the full name in block letters and as entered in qualifying examination certificate)

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

Contact no. (Mobile no.).................................................................. Any other alternative no.............................................................

E-mail ID (Compulsory)......................................................................................................................................................................

Blog / Website (if any)...................................................................................................................................................

2. (a) CAT Roll. No./Registration No. ........................................................... Month & Year of Examination ............................................

(b) XAT Roll. No./Registration No. ........................................................... Month & Year of Examination ...........................................

(c) MAT Roll. No./Registration No. ........................................................... Month & Year of Examination ..........................................

(d)CMAT Roll. No./Registration No. ......................................................... Month & Year of Examination ..........................................

(e) NMAT Roll. No./Registration No. ......................................................... Month & Year of Examination .........................................

3. (a) Father's Name (As entered in qualifying examination certificate) .................................................................................................

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

Occupation:.........................................................................................................................................................................................

Office Address:...................................................................................................................................................................................

Contact No. (Mobile No)................................................ Landline No. (with STD code) .......................................................................

E-mail ID:............................................................................................................................................................................................

(b) Mother's Name (As entered in qualifying examination certificate) ...............................................................................................

......................................................................................... Occupation: ..............................................................................................

Office Address:...................................................................................................................................................................................

Contact No. (Mobile No)................................................ Landline No. (with STD code) .......................................................................

E-mail ID:............................................................................................................................................................................................
4. Permanent Address:..........................................................................................................................................................................

...................................................................................... Landline No. (with STD code)........................................................................

5. Date and Place of Birth (As per Class X Certificate)

Date ........................... Month.................................... Year........................................ Place..............................................................

6. Nationality:.........................................................................................................................................................................................

7. State of Domicile:................................................................................................................................................................................

8. Category (Please tick ü in the appropriate box): (Kindly attach the proof except general category)

c General c SC c ST c OBC c Others (Please Specify).................................................

9. Blood Group:.............................................

10. Gender: c Male c Female

11. Marital Status (Please tick ü): c Married c Unmarried

12. Hostel Accommodation Required (Please tick ü): c Yes c No

13. Transport Facility Required (Please tick ü): c Yes c No

If yes. Specify the address from where it is required:......................................................................................................................

Note: Transport facility available from Chandigarh, Mohali, Panchkula, Zirakpur, Kharar, Ambala, Patiala, Rajpura, Kalka,
Pinjore andLudhiana.

14. Name and Address of the Institution last attended: ........................................................................................................................

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

15. Educational Qualifications (In order of X, XII, Graduation, Post Graduation):

Type of Year of Percentage

Courses
School/College Board/University Subjects or CGPA
Completed degree passing
secured

Std. X

Std. XII

Graduation

Post
Graduation

Any Other
16. Total Work Experience as on March 31st, 2019 Years:....................... Months:...............................

Work Experience Details

Name of the Organization Designation Held Number of

S.No. Nature of Responsibilities
Year/Months

17. Any other Professional /Additional Qualifications/Membership of Professional Bodies, etc.

Type of Number of
S.No. Qualification Nature of Responsibilities
Professional Body Year/Months

18. (a) Were you ever debarred from any examination(s)? (Please tick ü) c Yes c No

(b) Were you ever punished for misconduct? (Please tick ü) c Yes c No

If yes, please furnish details: …………………………..............................................….......…………….......................................…………….

19. Please specify any achievement(s) in Co-curricular/NCC/NSS/Sports/Cultural activities etc.

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

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

20. Please specify any professional/academic achievements:

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

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

21. Declaration to be signed by the candidate:

I declare that I shall abide by the Statues, Ordinances, Rules, Orders etc. of the University that will be enforced from time to
time. I will submit myself to the disciplinary jurisdiction of the Vice-Chancellor and the authorities of the University who may be
vested with such power under the Act, Statues, Ordinances and the Rules that have been framed hereunder by the University. I
also declare that the information given above is true and complete to the best of my knowledge and belief; and if any of it is found
to be incorrect, my admission shall stand cancelled and I shall be liable to such disciplinary action as may be decided by the
University. The decision of the University will be final.

Place:……………………………..
..............................................…………………....
Date: …………………………….. Full signature of the candidate
22. Declaration to be signed by the Parent/ Guardian:

I undertake the responsibility of paying all dues of my son/daughter/ward regularly and for his/her due
compliance with all rules and regulations that are in force from time to time in the University.

Place: ……………………………..

...........................................………………………....
Date: …………………………….. Full signature of the Parent/ Guardian

______________________________________________________________________________________________
_

ENCLOSURE CHECKLIST (Tick whichever is applicable)

1. Self Attested Certificate and Mark sheet of Class X , XII & Graduation
2.
3.
4.
Character Certificate from the institution last attended
Medical Fitness Certificate
Migration Certificate from the University attended last
} Format available on website www.chitkara.edu.in

5. Copy of Aadhaar Card

6. Reserved Category Certificate (if applicable)
7. If the form is downloaded - Bank Draft of Rs. 1100/- drawn in favour of Chitkara University payable at Chandigarh
8. Two recent passport size colour photographs. Photos need not be attested
9. Affidavit signed by Executive Magistrate/ Notary is required in case of gap in studies

Please Note :

= Chitkara University reserves the right to change/modify rules and regulations, fees charged, regulations
affecting students admissions, etc. or make any other suitable modifications.
= Right of Admission to the University is reserved. In case of any dispute, decision of the Vice Chancellor shall be
final and binding.
= Candidates who are finally selected will be admitted on the payment of the first instalment of fees by the dates
specified in the admissions letter, failing which their selection will stand automatically cancelled.
= Selected candidates will be required to submit the relevant documents including the qualifying degree
certificates and marks sheets latest by September 30, 2020.
= No intimation will be sent to the candidates who do not appear in the merit list and no correspondence will be
entertained on this account.

FOR FURTHER DETAILS CONTACT:

Chief Admission Officer

Chitkara University
SCO 160-161, Sector 9-C, Chandigarh.
Mobile +91.95011 05714 - 95011 05715.
Website : www.chitkara.edu.in
E-mail : [email protected]