UDAYBHANSINHJI
REGIONAL INSTITUTE OF COOPERATIVE
MANAGEMENT (URICM)– Gandhinagar
(An Institution of National Council for Cooperative Training, New Delhi)
(Funded by Ministry of Agriculture and Farmers Welfare
and Department of Cooperation, Govt. of India, New Delhi)
Sector-30, Gandhinagar-382030, Gujarat.
Telefax No. : 079-23260492, 23261715, 23260783, Mobile: 98985 67461
E-Mail: [email protected], [email protected], Website: www.urimanage.org.in
Application for Two Year Post Graduate Diploma in Management
(Agri. Business Management)
(Approved by the All India Council for Technical Education)
****
Mention the Test Scores (valid for Admission in 2017-19):
CAT
CMAT
MAT
GMAT
XAT
ATMA
Different
State
CET
Other
Passport size
Photograph
A) PERSONAL DETAILS (All in Capital Letters)
a) Name in Full (as written in High School/SSC Certificate)
b) Parent/Guardian’s name :
c) Parent’s Occupation
:
d) Address for correspondence
:
Landmark :
State :
Pin code:
e) Permanent Address
Landmark :
State :
Pin code:
Mobile No:
City :
Country :
Phone No with STD Code :
:
City :
Country :
Phone No with STD Code :
Fax No:
1
email ID:
f) Date of Birth :
G) Gender (Please tick) Male
Female
h) Indicate the category to which you belong to (Please tick and attach photo copy of certificate)
SC
ST
OBC (non-creamy)
Physically challenged
Others
B) EDUCATIONAL QUALIFICATIONS (Give details from 10th standard onwards)
Level of
Name of the
Board/
Year
Max.
Obtained
% of
Examination Examination University
Marks
Marks
Marks
10th
Standard
10 + 2
Class/
Grade
Graduation
Post
Graduation
C) WORK EXPERIENCE
Organization
Designation
Scale / Salary
Drawn
Period
From
To
D) OTHER RELEVANT INFORMATION
Extra-curricular activities: Give details of sports, games, hobbies and other activities you consider
worth mentioning including awards received, positions held in different association, etc.
E) DECLATION
 I declare that the information given by me in the application is true to the best of my
knowledge.
 I have read the prospectus and agree to abide by the rules and regulations of the
Institute.
 I hereby submit to the disciplinary jurisdiction of the authorities of the Institute and shall
observe and abide by the rules laid down by the Head of the Institute.
Place :
Date :
Signature of the Applicant