Siva Sivani Institute of Management

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APPLICATION FORM

*INSTRUCTIONS BEFORE FILLING THE APPLICATION

1. A D.D / Online payment for Rs. 1200/- payable at Hyderabad in favour of "Siva Sivani Institute of Management" must be taken.

2. All fields marked * - Mandatory should be filled.

3. Print the Acknoledgement slip found after submiting the application and attach it along with the
DD sent to SSIM if paid by DD.

4. Login to www.ssim.ac.in with the access credentials sent to your email address to Print Hallticket.

5. Paste your recent photograph on the space provided on Hallticket.

6. Carry all your copies of marks memos and the qualifying exams score card to GD/ Interview.

* Mode Of Selection
Residential Non-Residential

* Name of the Course Applied :

* Personal Details
* Last Name (Surname):
* Name :
* Father's Name/Husband's Name /Guardian's Name :
* Mother's Name :
* Date of Birth:
* Gender:	Male Female

Upload Your Photo here : (Maximum File Size is 1 MB)

Choose a zip file of certificates to upload : (Maximum File Size is 7 MB)

Parent / Guardian Occupation Profile:
Occupation & Address of the Parent/Guardian :
Profession :	Self Employed Salaried(Govt.) Salaried(Pvt.)
Name of the Employer/Business :
Net monthly Income :
No of years of service :
Telephone Office (With STD code):
Mobile No:
Email :

* Contact Address
* Address - Line1:		* Address - Line2:
* City:		* State:
* Country:		* Pin:
Telephone (With STD code):		Mobile:
* E-mail :		PassPortNo:
* Confirm E-mail :

* Educational Qualifications :
Examination	Board / University	Institution	Marks(%)	Year of Completion	Whether cleared in first attempt (Yes/No)	Medium of Instruction
* Class X
* Intermediate / +2
* Name of the Degree :		Other Degree Name :
* Year 1
* Year 2
Year 3
Year 4
* Aggregate 'Degree' Percentage of Marks (Excluding final year marks if still pursuing)

Name of the Post Graduation (If any) (MCA/MSc/Mcom/MTech/Others):
Year 1
Year 2
Aggregate 'PG' Percentage of Marks (Excluding final year marks if still pursuing)

Work Experience details(if any):
Name and Address of Organisation	Address	Designation	From Date	To Date	Period (Months)	Salary
1.
2.
3.

* Entrance Exams Appeared
Exam Composite Score Percentile	Exam Composite Score Percentile
MAT (SEP 2012)	CAT
MAT (DEC 2012)	ATMA
MAT (FEB 2013)	XAT
GMAT	ICET
CMAT

Note : Please visit our website "www.ssim.ac.in", for dates and venue of Group Discussion and Personal Interview
* Select your choice of place for Group Discussion and Personal Interview :
* Select Category :	General Category Industry Sponsored Category PIO/Foriegn National Category

What subjects interested you the most in your graduation ? :
Which newspaper do you read regularly? :
Computer Literate :
If Yes, Are you proficient in MS Word/ MS Excel :

What do you think are the top three qualities and/or attributes that a person joining a Business Managament Course must possess ? :

1.	2.
3.

What out of those listed above do you possess ? :

What are your reasons for choosing Management as your Profession/Career ? :

How did you come to know about SSIM?

MAT Bulletin	News Paper
Magazine	Friends & Relatives
Others(please specify)

What are your reasons for choosing SSIM for pursuing a course in management ? :

DECLARATION

I declare that all the information furnished in this application form is correct to the best of my knowledge. I understand and agree that in the event of any information being found to be incorrect or false, I will be refused admission and/or I will be debarred from continuing the course in this Institute. I have read the promotional material, prospectus and gone through other relevant counseling information and understood the requirements for the admission and completion of the course and confirm that I will abide by the rules and regulations of the Institute that are in vogue from time to time, in all respects.
I will comply with all rules of the Institute relating to discipline and ragging.

I Agree with the declaration mentioned above.

D.D details
* Payment Method
D.D Online Payment ( Secure Payment through Credit Card/Debit Card(Approved by Master/Visa) )
* Reference No :
* D.D Number :
* D.D Date:
* Bank Name :