stitute Name
 
 ADMISSION APPLICATION FORM
  If you are interested in more thanreturn false } else if ((usersign.p22.value == "")||(usersign.p24.value == "")) { alert("Pls Enter Your High School Detail"); usersign.p22.focus(); return false; } else if ((usersign.p25.value == "")||(usersign.p27.value == "")) { alert("Pls Enter Your Senior Secondary School Detail"); usersign.p25.focus(); return false; } else if ((usersign.p39.value == "")||(usersign.p40.value == "")||(usersign.p41.value == "")||(usersign.p42.value == "")) { alert("Pls Enter DD Detail"); usersign.p39.focus(); return false; } else if ((usersign.p43.value == "-1")) { alert("Pls Enter GD Location"); usersign.p43.focus(); return false; } else{ var gg = confirm("Are You Sure ,You Want To Save?"); if (gg==true) { usersign.submit(); }}} n>
one programme, please select programme in order of preference: olspan="2"> 
  Programme (1st Preference)     Programme(2nd Preference)  
       
  Please consider me in the category of admission in order of preference :
 Category(1st Preference)    Category(2nd Preference)  
       
 
 CAT Center Code               CAT Registration No  CAT Percentile (Nov 08)    
              (Upto 2 Decimal places Example 87.68)
   
  Please consider me in the category of admission in order of preference :
 Category(1st Preference)    Category(2nd Preference)  
     
 FILL THE INFORMATION IN CAPITAL LETTERS :
 Candidate Name ( in CAPITAL LETTERS AS GIVEN IN CAT APPLICATION FORM CUM ANSWER SHEET ) :
 
 Date of Birth :
  Please consider me in the category of admission in order of preference :
 Category(1st Preference)    Category(2nd Preference)  
     
02 male female   Nationality : Indian  Foreign
 Mailling Address :
 House No. :  Street :  City :
  State :
Pin Code:
 Tel. No:
 Mob. No. :
 E - mail ID :    Father's  Name  Parents'  Occupation :
 Academic Record : ( Please attach self attested copies of all certificates or mark sheets ) :
 Secondary/High School:  Year of Passing  Mode Agg. % Marks   State :
Pin Code:
 Tel. No:
 Mob. No. :
 E - mail ID :  
 Senior Secondary/ 10+2  Year of Passing  Mode  Agg. % Marks
 Graduation: University Name
College/In   State :
Pin Code:
 Tel. No:
 Mob. No. :
 E - mail ID :  
 Name Of Degree  Year of Passing  Mode  Agg. % Marks
 In case the final year result has not been declared; please gives aggregate/average percentage of previous  examinations and mention year/semester last cleared  Agg. % Marks
Year Sem
 ** Any Other Degree   Year of Passing  Mode  Agg. % Marks
 *Mode-Correspondence (CRP), Distant Learning Programme (DLP),Regular (RGL), **C.A. (INTER), CWA (INTER), C.S.(INTER), M.B.B.S (MBBS), B.V. Sc.(BVSC), Degree   in Hotel Management (BHM), B. Pharma (BPHARMA) , etc.
 Work Experience in MNC / listed Co. / Pvt. Co. / Family run business with minimum Rs. 50 Crore annual turnover and with minimum salary of Rs . 1.8 lac per annum only  to be mentioned ( Attached Extra Sheet required )
 Total Experience  in Months
 (to be considered subject to original experience certificates from the employer and its verification by the institute & submission of last audited balance sheet and income statement at the time of interview )
  Details of the bank Draft attached : Draft / banker's cheque for Rs. 1550 / - drawn in favour of BIRLA INSTITUTE OF MANAGEMENT TECHNOLOGY,  payable  at Greater Noida / Noida / New Delhi
 DD No :
 Date :
 Drawn on Bank :
 Branch :
  Kindly indicate your preferred location for GD / PI
 
 The social category of the candidate Gen OBC SC ST
 Declaration : This is to certify that the information provided by me in this form is true to the best of knowledge. In case of any discrepancy BIMTECH has full right to cancel  my  candidature. I undertake to produce the final graduation degree and mark sheets latest by 31st December 2009 , failing which BIMTECH will be free to cancel my  admission.
 Date :  Place :
 
   
 
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43" id="p43" style="width:140px;">    The social category of the candidate Gen OBC SC ST