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APPLICATION FORM
*INSTRUCTIONS BEFORE FILLING THE APPLICATION
1. A D.D for Rs. 1000/- 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
4. Marketing / HR classes commence from April, Triple Specialisation / BIFAAS classes commence from July
5. Login to www.ssim.ac.in with the access credentials sent to your email address to Print Hallticket.
6. Paste your recent photograph on the space provided on Hallticket
7. Carry all your copies of marks memos and the qualifying exams score card to GD/ Interview

* D.D Details
* D.D Number:       * D.D Date:      
* Bank Name :      

* Name of the Course Applied :      

* Personal Details
* Last Name (Surname):      
* Name :      
* Father's Name :      
* Mother's Name :      
* Date of Birth:       Day Month Year
     * Gender:       Male      Female

* 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(%) 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)

Entrance Exams Appeared
  Exam Composite Score / Percentile   Exam Composite Score / Percentile
  MAT (May 2010)     CAT
  MAT (Sep 2009)    ATMA
  MAT (Dec 2009)     XAT
  MAT (Feb 2010)    JMET

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

 Industry Sponsored Category
Computer Literate :    If Yes, Are you proficient in

MS Word/ MS Excel :      
How did you come to know about SSIM?
    News Paper       T.V      Internet
     Friends       Others

Work Experience details(if any):
Organisation Name Location Designation Period (Months)
1.  
2.  
3.  

Parent / Guardian Occupation Profile:      
Organization Name :       Designation :      
Telephone       
(With STD code):       		Mobile :      
Parent's Email :      

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 will abide by the rules, regulations, policies and procedures of the Institute that are in vogue from time to time, in all respects.



   I Agree with the declaration mentioned above.