APPLICATION COST : RS.
560/-
MBA UNIVERSITY OF MADRAS
APPLICATION NUMBER
MCA INSTITUTE OF DISTANCE EDUCATION
NrHf;if tpz;zg;gg; gbtk; / APPLICATION FOR ADMISSION
MBA / MCA
ENROLMENT NUMBER (to be assigned by the IDE office)
ACADEMIC YEAR 2024-2025 A 2 4
CALENDAR YEAR 2025 C 2 5
Candidate to tick () any one of the appropriate boxes
Differently Abled Visually Challenged Prisoner
for Tuition Fee Concession (Certificate to be enclosed)
Name of the Programme applied for MBA ELECTIVE chosen for IV Semester
Human Resource Finance Hospital
MCA Systems Marketing
MBA Logistics and Supply Chain Business Data Analytics
CANDIDATE TO FURNISH ALL THE REQUIRED PARTICULARS BELOW IN CAPITAL LETTERS
ADDRESS FOR COMMUNICATION
NAME : ——————————————————————––
Father’s Name : —————————————————————–—–
Recent Passport
Door No. & Street : ————————————————––––––––––––– Photograph to be
affixed
Town / Village Post : ————————————————————–—–—
District : ———————————————————–———–
State : ——————————————————––— INDIA
Pin code : —————————————————–————–—
Phone (Res) : ——————————— Off. ———–——————
Registered Mobile No.(RMN) : ——————————— e-mail –––––—————————————————
1. NAME OF THE APPLICANT (as given (a) in English :
in the certificate in CAPITAL LETTERS) (b) in Tamil:
2. Father’s/Guardian Name - Expansion of Initial
3. (a) Date of Birth as per T.C. (b) Age (c) Male d) Aadhaar No :
Gender Female
(Tick ) Transgender
4. Nationality INDIAN 5. Religion
6. a) Community (Tick ) b) Caste 7. Mother Tongue
OC / BC / MBC / DNC / SC / ST
8. Present Occupation
9. Selection of Project Work or Two Optional Subjects Project Work Two Optional Papers
10. Are you undergoing any other course in a College or
University ? If so, Specify
11. The wards of Defence Personnel / Ex-Servicemen (a) Ward of Defence Service Personnel
should specify as : (b) Ward of Ex-Servicemen : Navy / Army / Air force
12. DETAILS OF EXAMINATION PASSED
Examinations passed Name of the Month & Year Registration Class with Maximum
with Subjects School / College Board / University of Passing Number Grade / Marks Marks
S.S.L.C. / 10th Std.
P.U.C. / Higher Secondary
Diploma Course in
_________________________
Name of the Under
Graduate passed
_________________________
13. Do you have Academic Bank of Credit (ABC ID)? Yes No
If, yes, furnish the ABC ID No. ______________________________________
14. Enclosures
S.S.L.C Statement of Marks HSC Statement of Marks / Diploma Statement of Marks
UG Statement of Marks / Provisional / Degree Transfer Certificate / Course Completion Certificate
Migration Certificate (Other State Students only) Undertaking if any (Certificates due)
I hereby declare that all the particulars given above are correct and I agree to abide by all the Rules and Regulations
of the University that are in force from time to time.
Station :
Date : SIGNATURE OF THE APPLICANT
FOR OFFICE USE ONLY
1. The particulars furnished in the application have been duly verified with Originals and the Candidate is eligible for
admission
2. Admission / Cancellation Intimation given / sent on ........................................................
3. Submission of undertaking on ........................................................ is to be given.
ASST. /ASO SECTION OFFICER ASSISTANT REGISTRAR DIRECTOR
Received the Provisional admission intimation and all the original
certificates submitted by me
Signature of the LSC Co-ordinator with Seal SIGNATURE OF THE APPLICANT WITH DATE
Fees and Course Completion Details
i. First Year Fees ____________ Date __________ ii. Second Year Fees __________ Date __________
iii. CC Serial No. and Issued Date ________________________________
UNIVERSITY OF MADRAS
INSTITUTE OF DISTANCE EDUCATION
COMPUTER CODING SHEET
1. Course to which admission is sought :
Name of the Programme applied for MBA ELECTIVE chosen for IV Semester
MCA Human Resource Finance Hospital
Systems Marketing
MBA
Logistics and Supply Chain Business Data Analytics
2. ENROLMENT NUMBER (to be assigned by the office)
ACADEMIC YEAR 2024-2025 A 2 4
CALENDAR YEAR 2025 C 2 5
3. Name of the Candidate (Write in Capital Letters) (a) in English (b) in Tamil
(a)
(b)
Aadhaar No.
5. Father’s/Guardian Name (Write in Capital Letters) – as per entry in the Transfer Certificate
6. Mother’s Name (Write in Capital Letters)
Date Month Year
7. Date of Birth
8. Gender Male Female Transgender
9. Address for communication (do not write your name here)
City Pincode
Mobile : e-mail :
10. Selection of Project Work
a) Project Work b) Two Optional Papers
or Two Optional Papers
11. Nationality INDIAN 12. Region Urban Rural
13. Religion
14. Caste
15. Community SC ST MBC DNC BC OC
16. Differently abled Candidates YES NO 17. Are you employed ? YES NO
18. Are you a ward of a Defence Service Yes Category
Personnel ? (Army / Navy / Air Force) No
19. Are you a ward of an Ex-service person ? Yes No
20. Tuition Fee Concession Opted ? Differently Abled
(Candidate to tick ( ) any one of the appropriate boxes) Visually Challenged
Candidates can avail any one of the concession Prisoner
21. Do you have Academic Bank of Credit Yes No
(ABC ID) ? If yes, furnish the ABC ID No. __________________________________
22. Centre at which you propose to attend the Name
Personal Contact Programme (PCP) Code No.
Affix
Passport Size
Photo
Not to be attested
Station :
Date : Signature of the Candidate
