AKGIM/ADM/FM/25
AJAY KUMAR GARG INSTITUTE OF MANAGEMENT
MIS-FORM
(To Be Filled In Capital Letters By I Year MBA Student)
1. STUDETN NUMBER (Mentioned on Fee Receipt) :
2. NAME OF STUDENT :
3. MOTHER’S NAME :
4. FATHER’S NAME :
i) OCCUPATION :
ii) DESIGNATION :
iii) CURRENT PLACE OF POSTING :
iv) ANNUAL INCOME :
v) FATHER CONTACT NO. :
5. SEX : Male Female
6. DATE OF BIRTH (As per 10th Certificate) :
7. MODE OF ADMISSION : CUET DIRECT & OTHERS
8. 10th , 12th , & GRADUATION DETAIL :
i) NAME OF BOARD (10th) :
ii) 10th PASSING YEAR :
iii) AGGREGATE % MARKS IN 10th :
iv) NAME OF BOARD (12th) :
v) 12th PASSING YEAR :
vi) AGGREGATE % MARKS IN 12th :
vii) MARKS OBTAINED IN ENGLISH PAPER IN 12th :
viii) NAME OF COLLEGE/UNIVERSITY (GRADUATION):
ix) GRADUATION PASSING YEAR :
x) % MARKS IN GRADUATION :
Page 1 of 2
9. WORK EXPERIENCE :
a) No of Years :
b) Name of Organisation :
10 COUNSELLING ROLL NO :
11 RANK IN CUET/CMAT/CAT/MAT : RANK
(GENERAL):
: RANK (CATEGORY):
: Percentile…………………
12 E-Mail id :
13 HOSTLER : Yes: No
14 RELIGION :
15 CASTE CATEGORY: (SC, ST, OBC, GEN) :
16 CASTE SUB CATEGORY :
17 MINORITY COMMUNITY : Yes: No
18 DOMICILE :
19 FULL CORRESPONDENCE ADDRESS WITH PIN CODE & TELEPHONE/MOBILE NO.
20 FULL PERMANENT ADDRESS WITH PIN CODE & TELEPHONE/MOBILE NO.
21 FULL LOCAL GUARDIAN’S ADDRESS WITH PIN CODE & TELEPHONE/MOBILE NO
C/O
Name of Student:
Signature & Date:
Page 2 of 2
