2011 XIME APPLICATION NO 17 -

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 : [email protected] Website: www.xime.org

APPLICATION FOR TWO-YEAR PGDM PROGRAMME

1. (a) XAT ID (2011)
(b) CAT Registration No. (2010)
(c) ATMA Registration No. (2010)
(d) XAT Score in percentile (2011)

(e) CAT Score in percentile (2010) — in lieu of XAT

(f) ATMA Score in percentile (2010) — 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)

DD MM YY
Date of birth Age as on 1/7/2010

Gender M/F Marital status Married Unmarried

Candidates to affix
passport size photograph
Religion Mother tongue and sign across

Category SC ST BC OBC Others

(Tick)

Nationality NRI Yes No

Details of Parents Father Mother

Name

Occupation / Position

4. Mailing Address Permanent Address

……………………………………… ………………………………………

……………………………………… ………………………………………

……………………………………… ………………………………………

PIN PIN

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

Mobile No. Email address:

5. Languages known (other than English)

Language Read Write Speak

6. Academic Record
Name of School,
Year Major Total Max. % Marks
Qualification Board, College,
From—To Subjects Marks Marks (Aggregate)
University & Place

Std X

Std XII / PUC

**
Degree B.A. / B.Sc./
B.Com./B.Tech .
(  one applicable)
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 minimum
aggregate of 50% for all subjects together (45% for SC/ST candidates)

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

Level Academics Sports/ Games Cultural Events

School Level
(upto 2nd position)
College Level
(upto 2nd position)
University / State Level
(upto 10th position)
National Level
(upto 20th position)

NCC / NSS Participation Yes No

If Yes, give details
8. List Work Experiences (of duration at least 6 months)
Date
Organization Designation Annual Salary Reasons for Leaving
From To

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 )

Newspaper Magazine Coaching centre Other sources (specify)

XIME website XIME Student Alumni ……………………………...

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

If Yes, give details

XIME APPLICATION NO 17 -

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

 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 admission 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. Candidates should write their 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 XIME APPLICATION NO 17 -

Interview date

Interview batch no.

Reporting time

Interview centre Bangalore Chennai Hyderabad Kochi

XIME APPLICATION NO 17 -

Interview date 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 8733 / 0019 E-mail : [email protected] Website: www.xime.org

APPLICATION FOR TWO-YEAR PGDM PROGRAMME

Instructions for Filling 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 service to ensure delivery.
The item numbers refer to the serial numbers in the application form
Item 1 (d)
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 the application form. If XAT score card isn’t available yet, a printout of
XAT online score card should be furnished.
Item 1 (e)
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)
Alternatively, the ATMA score (Total Percentile) should be entered if received at the time of application. A
photocopy of the ATMA score card should be attached with the application form.
If XAT or CAT or ATMA scores are not received at the time of filling up the application, a copy of either of the
score cards must be sent by email / post so as to reach XIME latest by February 16, 2011. Without copy of XAT
or CAT or ATMA score card the application will not be considered.
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 & Place’, you are required to give the name of the
institution, its location and the 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 the 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 the admission rules, applicants must have a minimum of 50% aggregate marks (45% for SC/ST
candidates) in the degree examination. Refer 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.
Item7. 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 be ‘Participated 3 times in annual drama events’; or, for
university level under Sports/ Games, it can be ‘2 nd prize for high jump in inter-college sports’.
Enter only such data that can be substantiated with original certificates at the time of interview.