MBA/PGDM Application Form, Delhi NCR

Application No: MBA-PGDM/2024/10393

Program and Application Detail

MBA HUMAN
Campus IILM UNIVERSITY GREATER NOIDA Program RESOURCE
MANAGEMENT
Personal Details
Title MR First Name BHASKAR Middle Name
Last Name AGRAWAL Date of Birth 05/04/2002 Gender MALE
Alternate Mobile
Email Address [email protected] Mobile Number +91-9044935847
Number
Blood Group B+ Category GENERAL Nationality INDIAN

Address Details
Address for Correspondence
Country INDIA State UTTAR PRADESH District VARANASI
B31/80-12 AHILYA BAI
City VARANASI Address Line 1 Address Line 2 LANKA VARANASI
COLONY
Is Permanent
Address Same As
Pincode 221005 YES
Address For
Communication?
Permanent Address
Country INDIA State UTTAR PRADESH District VARANASI
B31/80-12 AHILYA BAI
City VARANASI Address Line 1 Address Line 2 LANKA VARANASI
COLONY
Pincode 221005

Family Details
Father's Details
Father's Title MR Name PAWAN KUMAR GUPTA Mobile Number +91-9450527718
GOVERNMENT
Email Address [email protected] Education PG Occupation
SECTOR
Name Of
LIC OF INDIA
Organization
Mother's Details
Mother's Title MRS Name PUNAM AGRAWAL Mobile Number +91-9450527718
Email Address [email protected] Education UG Occupation HOMEMAKER
Name Of
Organization
Local Guardian Details
Guardian Title Name Mobile Number
Email Address Education Occupation
Name Of
Organization

Academic Qualifications
10th Details

10th Year of
10th School/Institute Name 10th Board 10th Marking Scheme 10th Obtained Percentage/CGPA
Passing
CENTRAL BOARD OF SECONDARY
10 BNS ENGLISH SCHOOL 2018 PERCENTAGE 57.66
EDUCATION (CBSE)

After 10th
12TH
Qualification
12th Details

12th Board / 12th Year of 12th Marking 12th Obtained

12th School/Institute Name 12th Stream Result Status
University Passing Scheme Percentage/CGPA
PURVANCHAL BAL SHRAMIK NATIONAL INSTITUTE
12 COMMERCE 2021 DECLARED PERCENTAGE 78.33
MADHYAMIK VIDYALAYA OF OPEN SCHOOLING

Diploma
 Diploma Diploma Diploma Year of Result Diploma Marking Diploma Obtained
Diploma Name
University Stream Passing Status Scheme Percentage / CGPA
Diploma

MAHATMA GANDHI
Graduation
Graduation State UTTAR PRADESH KASHI VIDYAPEETH,
University
UTTAR PRADESH
Graduation
BBA
Degree
Graduation Details

Graduation Institute Graduation Stream Graduation Percentile Graduation Year of Passing Graduation Result Status
UG SCHOOL OF MANAGEMENT SCIENCE MANAGEMENT 2024 AWAITED

Do you have any

other NO
qualification?
Other Education Details

Other Other
Other Education Other Education Other Education Other Education Other Education Obtained
Education Education
Institute Name Board/University Year of Passing Marking Scheme Percentage/CGPA
Degree Stream
1

Work Experience Details

Do you have any
NO
work experience?
Work Experience Details

Organisation Name Designation Job Profile Start Date End Date Duration In Duration
1

Additional Details
Academic Honours (If any
academic awards or
recognition apply for
scholarship)
Discipline Information

Extracurricular Activities
NSS Volunteer

How will you contribute to IILM?

Have you ever been

placed on probation,
suspended, removed,
Hostel Facility Required ? NO Domicile of UTTAR PRADESH (UP) NO
dismissed or expelled
from any academic
programme ?

Enter details here

Have you at any time been

convicted by a court for NO
any criminal offence?

Enter details here

Have you ever been

suffered or/are suffering
from any NO
chronic/contagious
disease?

Enter details here

Have any of your relatives

or friends studied in any of NO Relative Name Relative Email
our Programmes?
Relative Programme
Relative Programme Relation Type
Year
How did you get to know
FRIENDS/RELATIVES Are you applying as a FIRST YEAR STUDENT Semester
about IILM ?
Anti Ragging
Academic Bank of
DigiLocker ID No. Undertaking Reference
Credit ID No
No

Upload Documents
Upload Your Recent Photograph Upload Your 10th Upload your 12th
YES YES YES
: Marksheet : Marksheet :
 Upload Your UG Marksheet
Upload Diploma Marksheet : NO Upload Your Score Card : NO NO
:

Declaration
Declaration
I DECLARE THAT ALL INFORMATION IN MY APPLICATION IS COMPLETE, FACTUALLY CORRECT, AND HONESTLY PRESENTED. I HAVE READ THE RULES AND REGULATIONS MENTIONED IN THE
PROSPECTUS AND WILL ADHERE TO THE SAME.

Applicant Name BHASKAR AGRAWAL Parent Name PAWAN KUMAR GUPTA Date 27/02/2024
Place VARANASI checkbox I AGREE