Pandit Deendayal Petroleum University

(Established by the State Act)

Institute of Petroleum Management, Gandhinagar
MBA (Focused on Oil & Gas Sector)
Application Form (Admission 2009)

Application Form No.:

(To be filled by Office)

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Address for Sending the Application Form (To be send only by Registered Post : not by Courier/Speed
Post)
Admissions 2009
MBA (Focused on Oil & Gas Sector)
Institute of Petroleum Management, Gandhinagar
Off Koba-Gandhinagar Highway,
Raisan, Gandhinagar-382 007
Gujarat-India
Personal Details (Please fill up in CAPITAL LETTERS):
Candidate Name:

CAT Registration No.:

Date of Birth:

Year:

Age as on 31/01/2009

Gender:

Month:

Fathers Name:

Nationality:

Category:

(GENERAL/SC/ST/Any Other) Please specify

Address for Correspondence (in CAPITAL LETTERS):

Permanent Address (in CAPITAL LETTERS):

Email ID:
Contact Numbers:

Mobile

Residence

Office

Fax

Academic Background

Examination
SSC
HSC
Graduate
Post Graduate
Any Other

University/Board

Principal Subjects

Year of
Passing

Percentage/CGPA

Employment Details:
Current Designation:

From Date:

Year:

Month:

Name of the Employer / Company:

Total Professional Exposure

Years:

Months:

Total Professional Exposure in Relevant Sector (Oil & Gas)

Years:
Months:
Prizes, Awards, Honors, Scholarships received or Other Academic Distinction:
Accomplishment
Year
Awarded by
Prizes, Awards,
Honors, Scholarships

Activities and Other interests:

Activity
Duration

Role Played

National / State /
Local

Awarded/Recognition

National / State /
Local

Application Fee Payment Details :

DD of Rs.2000/ to be made in favour of Institute of Petroleum Management Gandhinagar - PDPU, payable
at Ahmedabad
Cheque/ DD No.:

Date:

Amount:

Drawn on (Bank Name):

Full branch address:

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.
Place:
Date:

Signature of the Applicant

Acknowledgement
Name :

Application Form No.:

(To be filled by Office)

Address:
Pin:
Contact No.:
Email ID:

Programme: MBA (Focused on Oil & Gas Sector)

Pandit Deendayal Petroleum University
(Established by the State Act)
Institute of Petroleum Management, Gandhinagar
Off Koba-Gandhinagar Highway,
Raisan, Gandhinagar-382 007, Gujarat-India
Phones: +91 79-23276911 to 18
Website: www.ipmg.ac.in

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