WEST BENGAL UNIVERSITY OF TECHNOLOGY


STATE LEVEL ENTRANCE TEST FOR ADMISSION TO MBA PROGRAMMES
JEMAT 2010 (CONTINUATION OF SPECIAL TEST)
CONDUCTED BY SCHOOL OF MANAGEMENT AND SCIENCES, WBUT
Form No.  105191

Application Form 

CHOICE OF 
TEST CENTRE:
     CODE                          NAME

       PHOTO

CATEGORY:

GENERAL        SC        ST       OBC        PH      

 RELEVANT QUALIFICATION
QUALIFICATION

YEAR OF PASSING

% OF MARKS

G.P.A/Scale

Appeared

MARKS/G.P.A

10th     eg 1995    
12th                
10+2+3(MIN)              
 EXAMINATION FEES DETAILS
DD NO     BANK AND BRANCH  
AMOUNT(Rs.) DD DATE / /     (EG.19/11/08)
PERSONAL DETAILS
NAME GENDER   MALE           FEMALE
PARENT'S NAME NATIONALITY
DATE OF BIRTH  /  / (eg 02/05/1998)
ADDRESS FOR  
COMMUNICATION
    CITY/TOWN
STATE PIN
E MAIL ID:
(If any.) 		CONTACT NO
PHONE /MOBILE 		 

Declaration

  I hereby declare that I have read and understood the conditions of eligibility for the programme for which I am appearing in the JEMAT 2010 examination. I fulfill the minimum eligible criteria and I have provided the necessary information in this regard. In the event of information being found incorrect or misleading, my candidature shall be liable to cancellation at any time and I shall not be entitled to get refund of any fee paid by me. Further, I have carefully read all the instructions and I accept them and shall not raise any dispute in future over the same.

_______________________                               
Signature of the Applicant