Xime Application File

XIME APPLICATION NO 182012

XAVIER INSTITUTE OF MANAGEMENT & ENTREPRENEURSHIP

Fax: [phone] E-mail : [e-mail] Website: www.xime.org

APPLICATION FOR TWO-YEAR PGDM PROGRAMME

1. (a) XAT ID (2012)

(b) CAT Registration No. (2011)

(c) XAT Score inpercentile (2012)

(d) CAT Score in percentile (2011) - in lieu of XAT

2. Preferred GD/Interview Centre Bangalore Chennai Hyderabad Kochi

(Please circle)

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

Date of birth MM YYAge as on 1/7/2011DD

Gender Marital status Married UnmarriedM/F

Candidates to affix passport size photograph Religion Mother tongueand sign across

Category SC ST BC OBC Others (Tick)

Nationality NRI Yes No

Details of Parents Father Mother

Name

Occupation / Current Job

4. Mailing Address with PINPermanent Address with PIN

Contact : Tel No. (with STD code) : Tel No. (with STD code):

Email address :

Mobile No.
5. Languages known (other than English):

Language Read Write Speak

6. Academic Record

Year Name of School, Major Total Max. Marks
Qualification
% (Aggregate) From - ToBoard, College SubjectsMarks University & PlaceobtainedMarks

Std X

Std XII / PUC

Degree B.A. / B.Sc/
B.Com./B.Tech.

one applicable)
(P
Others (specify)

P.G. Degree
(specify)

Other Recognized
Course(of duration
1 year or more)

** Applicants are required to have a bachelor’s 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)

LevelAcademicsSports / GamesCultural Events

School Level
(upto 2nd position)

College Level
(upto 2nd position)

University / State Level
(upto 10th position)

National level
(upto 20th position)

NCC / NSS ParticipationYes No

If Yes, give details
8. List Work Experiences (of duration at least 6 months)

Date OrganizationDesignationAnnual SalaryReasons for Leaving FromTo

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)

NewspaperMagazineCoaching centreOther sources (specify)

websiteXIME StudentAlumniXIME

11. Have you ever applied to XIME before ? Yes No

If Yes, mention year

CARDXIME APPLICATION NO 18INTERVIEW

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 XIME’s 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.

Office Use XIME APPLICATION NO 18For

Interview date

Interview batch no.

Reporting time

Interview centre Bangalore Chennai Hyderabad Kochi

CARDXIME APPLICATION NO 18INTERVIEW

Interview dateReporting timeInterview batch no.

Address of Interview Centre

Candidates to affix passport size photograph and sign across

Name of applicantXIME seal XAVIER INSTITUTE OF MANAGEMENT & ENTREPRENEURSHIP Electronics City, Phase-II, Hosur Road, Bangalore - 560 100, Tel : 080 - 2852 8597 / 98 Fax: [phone] E-mail : [e-mail] 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 c

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 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.