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    Application - Form - ITM PGDM 2023 05461

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    mayank pethkar
    Mayank Pethkar has applied for the PGDM program at ITM Business School for the 2023-25 batch. He provides personal details including name, date of birth, gender, address, contact information, and education qualifications. He has completed his 10th and 12th from Shri Shankaracharya Vidyalaya in Bhilai and graduated with a B.Arch degree from St. Thomas College in Bhilai in 2023. He does not have any work experience. He is referred by Rupesh Sharma and declares that the information provided is true.

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    Application - Form - ITM PGDM 2023 05461

    Uploaded by

    mayank pethkar
    37 views2 pages
    Mayank Pethkar has applied for the PGDM program at ITM Business School for the 2023-25 batch. He provides personal details including name, date of birth, gender, address, contact information, and education qualifications. He has completed his 10th and 12th from Shri Shankaracharya Vidyalaya in Bhilai and graduated with a B.Arch degree from St. Thomas College in Bhilai in 2023. He does not have any work experience. He is referred by Rupesh Sharma and declares that the information provided is true.

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    Original Title

    Application_form_ITM-PGDM-2023-05461

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    Mayank Pethkar has applied for the PGDM program at ITM Business School for the 2023-25 batch. He provides personal details including name, date of birth, gender, address, contact information, and education qualifications. He has completed his 10th and 12th from Shri Shankaracharya Vidyalaya in Bhilai and graduated with a B.Arch degree from St. Thomas College in Bhilai in 2023. He does not have any work experience. He is referred by Rupesh Sharma and declares that the information provided is true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views2 pages

    Application - Form - ITM PGDM 2023 05461

    Uploaded by

    mayank pethkar
    Mayank Pethkar has applied for the PGDM program at ITM Business School for the 2023-25 batch. He provides personal details including name, date of birth, gender, address, contact information, and education qualifications. He has completed his 10th and 12th from Shri Shankaracharya Vidyalaya in Bhilai and graduated with a B.Arch degree from St. Thomas College in Bhilai in 2023. He does not have any work experience. He is referred by Rupesh Sharma and declares that the information provided is true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ITM BUSINESS SCHOOL

    APPLICATION FORM 2023-25


    ONLINE FORM SERIAL NO:ITM-PGDM-2023-05461

    Applicant's Personal Details


    First Name Mayank
    Middle Name
    Last Name Pethkar
    Mobile No. +91-9109828379
    Email ID [email protected]
    Date Of Birth 30/10/2002
    Gender Male
    Facebook User ID/ Login ID
    Instagram Id beatalbeatbox

    Address Details
    Is Permanent Address Same as Communication Address: Yes
    Communication Address Permanent Address
    Address Line 1 Mig- 1/416 Mig- 1/416
    Address Line 2 Hudco,amdinagar Hudco,amdinagar
    Country Name India India
    State Name Chhattisgarh Chhattisgarh
    District Name Durg Durg
    City Name Durg Durg
    Pin Code 490009 490009

    Parent's Details
    Father's Details Mother's Details
    Name Late Mukund Pethkar Kanta Pethkar
    Email Address [email protected]
    Mobile Number +91-9301663078 +91-9691235537
    Occupation Other| Housewife

    Preference Details
    Campus Preference Specialization
    1 ITM Business School, Kharghar (Navi Mumbai)
    2
    Process Location (GD/PI Centre): Raipur

    Educational Qualifications
    10th 12th Graduation Post-Graduation
    Shri Shankaracharya Shri Shankaracharya
    Institution St. Thomas College, Bhilai
    Vidyalaya ,Hudco , Bhilai Vidyalaya ,Hudco , Bhilai
    City Bhilai Bhilai Bhilai
    Mode of
    Regular Regular Regular
    Education
    Board/Univer Central Board Of Secondary Central Board Of Secondary Other|Hemchand Yadav
    sity Education (CBSE) Education (CBSE) Vishwavidyalaya,Durg
    Stream _ Commerce Management
    Degree SSC HSC B.Arch
    Year of
    2018 2020 2023
    Passing
    Marking
    Percentage Percentage Percentage
    Scheme
    Percentage/C
    58.6 63.6 70.8
    GPA
    Additional Qualifications
    Type of Qualification Name of the Institution Year of Completion Percentage of Marks
    1
    2
    3
    4

    Test Scores:
    Result
    Registration Date of Test Rank Score Obtained Percentile Obtained
    Status
    CAT
    XAT
    GMAT
    CMAT
    MAT
    ATMA
    STATE CET
    NMAT BY GMAC

    Work Experience & Referral Information


    Monthly
    Company Designation From Year To Year Reason of Leaving
    Remuneration
    1
    2
    3
    Total Period of Work Experience (In Months):
    Referrer Details:
    Referrer Mobile
    Referrer Is Professional/Others Referrer Name Rupesh Sharma +91-9993600022
    No.

    Declaration
    The Admissions Committee Of ITM Has Final Authority Over All Admission Matters. All Disputes Pertaining To Matters Of Admission And Its
    Terms And Conditions Are Subject To Mumbai Jurisdiction And No Other Court Shall Have Jurisdiction In This Matter.
    I Hereby Certify That The Above Information Is True To The Best Of My Knowledge. I Authorize INSTITUTE FOR TECHNOLOGY AND
    MANAGEMENT And Any Of Its Employees To Use The Information Contained In This Application In Any Manner Its Seems Necessary For The
    Purpose Of Admission Into Its Programs.

    Applicant Name: Mayank Pethkar Parent Name: Late Mukund Pethkar


    Date: 20/03/2023

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