Full Name*

    Permanent Address

    Mobile No.*

    Email Id*

    Date of Birth*

    Father Name*:

    Father's Occupation:

    Father's Mobile No.*:

    Gender:

    Hostel Accommodation Required

    YesNo

    Course:

    Qualification

    Name of Examination

    Board/University/Institute*

    Year of passing

    % Marks obtained*

    Main Subjects

    Name of Examination

    High School

    Board/University/Institute

    Year of passing

    % Marks obtained

    Main Subjects

    Name of Examination

    Intermediate(10+2)

    Board/University/Institute

    Year of passing

    % Marks obtained

    Main Subjects

    Name of Examination

    Graduation

    Board/University/Institute

    Year of passing

    % Marks obtained

    Main Subjects

    Examination Details

    CAT

    Roll No.

    Score

    Percentile

    MAT

    Roll No.

    Score

    Percentile

    UPCET / UPSEE

    Roll No.

    Score

    Percentile

    CMAT

    Roll No.

    Score

    Percentile

    OTHERS

    Roll No.

    Score

    Percentile

    How did you find out about Jaipuria Institute of Management, Indirapuram Ghaziabad. Please specify the source.

     

    Declaration

    I hereby declare that the information given in the Application form is true to the best of my knowledge and belief. If any information is found to be wrong, i shall be liable for action. I hold myself responsible for the due and prompt payment of fees.