Management & Research Institute

Management & Research Institute
To
The Director,
Hubtown Solaris, 2nd Floor,
N.S. Phadake Marg, Near East West,
Flyover , Andheri (East),
Mumbai- 400 069
Affix your latest clear passport size photo here. (Do not staple or sign on photo)
-----------------------------------------------------------------------------------------------------------------------------------------Provisional Admission Form for Ph.D/MBA Program
Affix your latest
clear passport
size photo here.
(Do not staple or
sign on photo)
Session: …………………………
HO No./Registration No. ……………………………………….……………………..….
Signature here
Course ……………………………,Specialization ……………………….……………..
PERSONAL INFORMATION
1. Candidate Full Name in English ……………………………………………………………………………………………..………………
2. Father's Name ………………………………………………………………………………………………………………
3. Mother's Name
…………………….………………………………………………………………………………………
4. Husband Name ………………………………………………………………………………………………….……………
5. Sex (Male/Female) ……………. Cast: SC/ST/OBC/SBC/GEN. Date of Birth (DD/MM/YYYY)…….………...
7. Nationality: □ Indian / □ Other Country, Please Specify…………………………………………………..…………………………
8. Particular of Qualifying Examinations
S.No.
Exam Passed
Board/ University
Percentage
Year of Passing
9. Complete Postal Address
Pincode
Phone No. with Code
Mobile NO.
10. E-Mail id. ……………………………………………………………………………………………………………………………………………
11. Pre Qualifying Test GATE/NET/SLET/JRF/M.Phil or any other (for P.hD candidate)
Name of Passing
Year of Passing
Roll No.
Rank/ Percentage
12. Major Area of Research (for PhD candidate) ……………………………………………………………………………
………………………………………………………………………………….
13. Publication of Books / Referred Journal or any other extracurricular activity (if any), (for PhD candidate):
………………………………………………………………………………………………………………………………………………………
14. If Employed (Give detail) or Professional Experience
………………………………………………………………………………………………………………………………………………………
PARTICULAR OF SUGGESTED GUIDE/SUPERVISOR (If any), (for PhD candidate)
1. Name & Designation ………………………………………………………………………………………………………………………
2. Working Address……………………………………………………………………………………………………………………………
3. Correspondence Address (Residence)………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
DECLARATION BY CANDIDATE
I hereby declare that the information given in application form is complete and accurate. I understand and agree that
misrepresentation or concealment of facts will result in denial of admission, cancellation of admission, or expulsion. I am
aware of the fee structure and eligibility criteria for admission in the Board/University, I have read, understood and do
hereby give consent to the terms and condition of the Board/University ordinance for admission. I agree to abide by the
admission rules and decision taken by the Board/University authorities in all issue pertaining to admission and my
continuation as a student of the Board/University.
Place:
Date:
Signature of the Candidate
(The Demand Draft drawn in the favor of MRI, Payable at Mumbai, Should be sent to Director)
To
The Director,
Hubtown Solaris, 2nd Floor,
N.S. Phadake Marg, Near East West,
Flyover , Andheri (East),
Mumbai- 400 069
Fees Particulars:
Bank & Branch ……………………………………………………………….……
Amount ………………………………….…………..…
DD No………………………………………………………….
DD Date…………………………………………………………………………..
Checklist for Candidates
Documents to be submitted by Ph.D/MBA Candidates at the time of Admission
6 Passport Size Photographs.
Filled Application Form.
Attested copy of 10th Mark sheet & Certificate
Attested copy of 12th Mark sheet and Certificate
Attested copies of all Mark sheets and Convocation of Graduation
Attested copies of all Mark sheets and Passing of Post Graduation
Migration Certificate (Original)
Caste Certificate (For Relaxation in reserved category)
No Objection Certificate (In the case of Candidate working in any organization)
Signature of the Candidate
For O ce Use Only
I have checked the following documents which are essentials for the eligibility of the Ph.D/MBA Program
□ Proof of Date of Birth □ Migration Certi cate □ All Qualifying Exam Mark sheet. □ Caste Certi cate
Date:
Signature of O cials:
Management & Research Institute
Undertaking Form (By Student)
To
The Director
Institute of Management & Engineering Technology
Hubtown Solaris, 2nd Floor,
N.S. Phadake Marg, Near East West,
Flyover , Andheri (East),
Mumbai- 400 069
Sir / Madam,
This is to declare that I _______________________________________________ son / daughter of
__________________________________have taken admission in ______________________
Program in winter / summer 20___ in _________________________________________steam under Institute of
Management & Engineering Technology and I assure that all the documents enclosed Related to my qualification
regarding the admission are genuine and authentic.
In the event of suppression or distortion of any fact like educational qualification, 1documents related to nationality
and study period etc. made in application form. I understand that my admission is liable to be cancelled.
I am eligible for the examination as per the rules and regulations of the board. I shall be responsible for The
consequences if the information filled by me is found incorrect. if I am found ineligible for admission to a class, at
any stage my application will be rejected even if my result has been finally declared and Consequently such result
also would be void.
I have gone thought the rules, regulations and educational programs offered by the said board and on being fully
satisfied, I have applied for admission on my own. Hence I am aware that the programmers offered by the said
board come under Autonomous board and An ISO 9001: 2008 institution, however if I am unable to get advantage
out of said programmers after its completion, in securing job promotion and /Or for further advance studies on any
accounts and for any other reason, the said board will not be held Responsible in any manner and also undertake
not to claim.
Place: __________________Date: __________________
Signature of the Candidate