2013

XIME APPLICATION NO 19
XAVIER INSTITUTE OF MANAGEMENT & ENTREPRENEURSHIP
Electronics City, Phase-II, Hosur Road, Bangalore - 560 100, Tel : 080 - 2852 8597 / 98 Fax: 080-2852 0809 E-mail : admissions@xime.org Website: www.xime.org

APPLICATION FOR TWO-YEAR PGDM PROGRAMME

1. (a) XAT ID (2013) (b) XAT Score in percentile (2013) (c) CAT Registration No. (2012) (d) CAT Score in percentile (2012) - in lieu of XAT (e) CMAT Registration No. (Oct. 2012) (f) CMAT Score in percentile (Oct. 2012) Bangalore Chennai Hyderabad Kochi Pune

2. Preferred GD/Interview Centre (Please circle)

3. Name (in capital letters as in Degree Certificate /Mark Sheet)

Date of birth Gender Religion Category (Tick) Nationality SC

DD M/F

MM

YY

Age as on 1/7/2012 Married Unmarried

Candidates to affix passport size photograph and sign across

Marital status

Mother tongue ST BC OBC Others NRI Father Yes No

Details of Parents

Mother

Name 4. Occupation / Current Job Mailing Address with PIN Permanent Address with PIN

Contact : Tel No. (with STD code) : Email address : Mobile No.

Tel No. (with STD code):

5. Languages known (other than English): Language Read Write Speak

6. Academic Record
Qualification Std X Std XII / PUC Degree B.A. / B.Sc/ B.Com./B.Tech. (P one applicable) Others (specify) Year From - To Name of School, Board, College University & Place Major Subjects Total Marks obtained Max. % Marks Marks (Aggregate)

P.G. Degree (specify)

Other Recognized Course(of duration 1 year or more) ** Applicants are required to have a bachelors degree from a recognized university with a minium aggregate of 50% for all subjects taken together (45% for SC/ST candidates)

7. Awards, Scholarships, and Significant Achievements (Be specific)

Level School Level (upto 2nd position) College Level (upto 2nd position) University / State Level (upto 10th position) National level (upto 20th position) Academics Sports / Games Cultural Events

NCC / NSS Participation If Yes, give details

Yes

No

8. List Work Experiences (of duration at least 6 months)

Organization Designation Date From To Annual Salary Reasons for Leaving

Describe the nature of work and responsibilities associated with your most recent job

9. Explain why you have chosen to study at XIME.

10. How did you come to know about XIME ? (please P)

Newspaper XIME website Magazine XIME Student Coaching centre Alumni Other sources (specify)

11. Have you ever applied to XIME before ? If Yes, mention year

Yes

No

INTERVIEW CARD

XIME APPLICATION NO 19

If you are found eligible, you will be sent an interview card. Please write within the box below your name and mailing address, where you want the interview card to be sent.
Please write in capital letters

E-mail address :

Declaration I hereby declare that the particulars given in this application are true and correct and will be supported by original documents when required. I confirm that I have fully read the terms and conditions regarding the admissiion to XIMEs PGDM programme and pursuit of the same including those relating to withdrawal from the programme after admission. Place............................... Date................................. Signature of the applicant

Candidate must affix a passport size photo in the box given in the interview card and sign across. Candidate should write his/her name in the box at the bottom of the interview card. Other entries in the Interview Card will be filled at XIME.

For Office Use Interview date Interview batch no. Reporting time Interview centre

XIME APPLICATION NO 19

Bangalore Chennai Hyderabad Kochi Pune

INTERVIEW CARD
Interview date

XIME APPLICATION NO 19
Reporting time Interview batch no.

Address of Interview Centre

Candidates to affix passport size photograph and sign across

Name of applicant

XIME seal

XAVIER INSTITUTE OF MANAGEMENT & ENTREPRENEURSHIP

Electronics City, Phase-II, Hosur Road, Bangalore - 560 100, Tel : 080 - 2852 8597 / 98 Fax: 080-2852 0809 E-mail : admissions@xime.org Website: www.xime.org

APPLICATION FOR TWO-YEAR PGDM PROGRAMME

Instructions for filing the Application Form
Applicants are advised to send the completed application form and other documents such as score card or certificates, through registered post or courier to ensure delivery. If you have downloaded the application form from our website, please do not fill the application number. This will be filled by XIME Admission Office . The item numbers refer to the serial numbers in the application form. Item 1 b The XAT score (Total Percentile) should be entered if received at the time of application. A photocopy of the XAT Score card should be attached with application form. Item 1 d Alternatively, the CAT Score (Total Percentile) should be entered if received at the time of application. A photocopy of the CAT score card should be attached with the application form. Item 1 f CMAT scores released in October 2012 should be entered. A photocopy of the CMAT score card should be attached with the application form. Item 4. Mailing Address Please provide your email address. This will enable faster communication from XIME. Item 6. Academic Record Under the column Name of School, Board, College, University and Place, you are required to give the name of the institution, its location and affiliated board or university. Example: College of Engineering, Anna University, Chennai Under the column Major Subjects give the main subjects or electives. Example: For PUC one can write PCM to indicate Physics, Chemistry, and Mathematics as the major subjects. For Engineering, it can be Mech. with Industrial Engg. and so on Under column % of Aggregate Marks, the weighted average of the cumulative marks obtained in all the subjects including languages and in all the semesters or all the years as the case may be must be given. According to admission rules, applicants must have a minimum of 50% aggregate marks (45% for SC/ST candidates) in the degree examination. Refer the Programme Brochure. In case you are yet to appear for the final semester/year examination, cumulative marks of all previous semesters/years must be calculated and entered. Under the cell Degree, tick the degree applicable, or specify the name of other degree you hold. e.g. B.Pharm. Item 7 Awards Scholarships and Significant Achievements If you have an entry to make in Sports/Games column, indicate clearly the rank or position achieved. In Cultural Events indicate the extent of participation. Example: For college level, under cultural events, it can Participated 3 times in anuual drama events, or for university level under Sports/Games, it can be 2nd prize for high jump in inter-college sports. Enter only such data that can be substantiated with original certificates at the time of interview.