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Application form for Two Years Post Graduate Diploma in Management-Hybrid Program

(Distance Learning Mode)

Batch : ________________ Counseling /Enrollment Center : _________________________

Personal Details

Surname ____________________________________________

First Name ____________________________________________ Affix 1 passport size


photo here
Husband/Father's Name ____________________________________________

Date of Birth

( D D/M M /Y Y Y Y)

Gender MALE FEMALE

Preferred address for correspondence HOME OFFICE

Home Address Office Address


_______________________________________ _____________________________________________
_______________________________________ _____________________________________________
_______________________________________ _____________________________________________
City : _____________________________ City : ____________________________________
Pincode : _____________________________ Pincode : ___________________
State : ___________________ State : ___________________
Country : ___________________ Country : ___________________
Resi. Tele : ___________________ Office Tele : ___________________
Mobile No. : ___________________ Mobile No. : ___________________
Email Id : ______________________________ Email Id : ____________________________________
Aadhaar No.: ______________________________

Educational Background (Mention only your main or highest qualification as of date)


(College or University should be recognized by UGC / AICTE /State Govt. otherwise admission will be cancelled at any time.)
Examination Board / University Conducting the School / College Attended Year of Passing
Exam

Please mention if appeared for exam and result awaited .


Work Experience
Total Work Experience __________ Years
Name of Present Organisation Type of Industry Designation Nature of Work

Any Course done from the Welingkar Institute of Management


Course Name Year of Passing Roll No.

Preferred Specialization
Marketing ( ) E-Business ( ) Rural & Agri Business ( )
Finance ( ) International Business ( ) Healthcare Management ( )
Banking, Investment & Insurance Gen. Mgmt. ( ) Media & Advertising ( )
( )
Human Resource ( ) Retail ( ) Hospitality Management ( )
Operations ( ) Services Excellence ( ) E-Commerce ( )
Supply Chain ( ) Travel & Tourism ( ) IT Projects Management ( )
Fee Plan Selection:
Two years PGDM –HB (HPGD) Lateral Admission for Two years PGDM –HB (LPGD)
Fee Plan Amount Fee Plan Amount
2 years fees (without PCP) paid in advance  61,000/- Lateral Entry fees paid in advance  46,000/-
2 years fees (with PCP) paid in advance  64,600/- Lateral Entry Fees(26+22)  48,000/-
Yearly Fees (without PCP)  33,500/- Dual Admission for Two years PGDM –HB (MPGD)
Yearly Fees (with PCP)  37,100/- Fee Plan Amount
Yearly Fees (20.6+9.5+9.5) (with PCP)  39,600/-
Dual specialisation fees  33,500/-
Yearly Fees (17+9.5+9.5) (without PCP)  36,000/-
Payment Details
Payment Mode
Bank Name /
Sr. No. Date (Chq/Credit Card Amount Payment details
Branch Name
/Online /POS

PDC should be within 90 days


Exam Centers (to be selected only from the list of Centers mentioned on the welingkaronline.org website)
Exam Center Name : __________________________________________________
Student Undertaking
1) I undertake to keep sufficient balance in my bank account to honour the PDCs, given by me, on due dates.
2) In case, the cheque is dishonoured for any reason, | will pay the due amount along with the applicable cheque bouncing charges in cash or
through demand draft within 7 days of intimation of dishonour of cheque.
3) In case, I fail to pay the dues within 7 days, the Institute shall have the right to deactivate my online access till I make the payment.
4) In case, I am unable to pay my dues within 15 days, my admission will stand cancelled and the fees earlier paid by me will be forfeited and
I will not be eligible for any refund of fees earlier paid, if any
5) It would be assumed that students seeking admission to Welingkar’s Hybrid Management Programs have read the prospectus thoroughly
and understood all the rules and regulations described therein and agree to abide by the same.
6) It is the student’s responsibility to ensure that their contact details such as address for communication, e-mail id, mobile no. etc, maintained
by the Institute remain updated and current for the duration of the program.
Signature of Student _____________________ Executive Name ____________________________

Date _______________________________ Executive Signature __________________________

Verified by : _________________________________________ Branch Stamp


(Sign of Branch H.O. Executive)

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