PANDIT DEENDAYAL PETROLEUM UNIVERSITY

| SCHOOL OF PETROLEUM MANAGEMENT |

APPLICATION FORM

MBA
ADMISSION 2011

Padndit Deendayal Petroleum University

(Recognized by UGC)
School of Petroleum Management
Raisan, Gandhinagar, Gujarat, India, Pin: 382007
Phone: +91 79 23275109/19 Email: admissions@spm.pdpu.ac.in,
Website: www.spm.pdpu.ac.in, www.pdpu.ac.in

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 Personal Detail

CAT Registration No.

PLEASE AFFIX
PHOTOGRAPH
HERE

1. Name and Address of the candidate: (In Block Letters)

First Name

Middle Name

Surname

2. Correspondence Address
H.No. / Society / Area

City / Town State

Country Pin code
Phone No. with Country
& Area Code
Mobile No
Email ID

3. Permanent Address
H.No. / Society / Area

City / Town State

Country Pin code
Phone No. with Country
& Area code

2. Nationality: India Non-Indian

3. Gender: Male Female

4. Date of Birth: Age as on 31/01/2011

D D M M Y Y Y Y

5. Category: General SC ST PH

6. Blood Group:

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 7. Father’s Name

8. Mother’s Name

9. Parent’s / Guardian’s Occupation:

Agriculture Public / Govt. Service Teaching/Research Private Service

Engineering Defense Law Medical Business

Other (Specify): _______________________________________________________________

10. Parent’s / Guardian’s Total Annual Income (in Rupees):

Below 2 Lakh Between 2-4 Lakh Between 4-6 Lakh Above 6 Lakh

Other (Specify): _______________________________________________________________

Academic Detail

11. Academic Background

Examination University / Board Principal Year of Percentage /
Subjects/Specialization Passing CGPA
SSC

HSC

Graduate
(Please Specify)
Post Graduate
(Please Specify)
Any other
(Please Specify)

12. Prizes, Awards, Honors, Scholarships received or other academic distinction:

Prizes, Awards, Accomplishment Year Awarded by National /
Honors, Scholarships State / Local

13. Activities and other interests:

Duration Activity Role Played Award / Recognition National /
State / Local

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 Employment Detail

14. Employment History (list from the most current employment)

Name of Employer Designation Nature of job From To

15. Total Work Experience Years Months

16. Total Professional Experience in Energy & Infrastructure Sector: Years Months

GD / PI Centre

17. If shortlisted I would like to appear for GD and PI at the following centre: (Please check
one box)

Bengaluru Delhi Gandhinagar Hyderabad Kolkata Mumbai

Note: In case there are only a few candidates in any of the above centres, they can be called to the nearest centre

Application Fees Payment Detail

Demand Draft of Rs.2000/- to be made in favour of Pandit Deendayal Petroleum University, payable at
Ahmedabad”.

DD / Cash Receipt No. Date Amount

Drawn on (Bank Name)

Full Branch Address

Alternatively, you can directly deposit the application fee of Rs.2,000/- in Oriental Bank of Commerce A/c
No.09331131002245 and attach the copy of deposit receipt (Please mention name and CAT Registration
Number with the filled application form).

Submission of Application Form:

Application with required details and payment should be submitted to the institute by registered post or
alternatively by DTDC Courier services. DTDC delivers the mails at the University Campus on a daily basis.
Details of DTDC courier branches can be obtained from www.dtdc.com.

DECLARATION

I have carefully read the instructions and agree to abide by the decisions of the Institute regarding my selection
to the programme. I certify that the information furnished in this application form is correct to the best of my
knowledge and belief.

Date: __________________

Place: _________________ Signature of the Candidate

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