Institute Of Rural Management Anand
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INSTITUTE OF RURAL MANAGEMENT ANAND
Form No: 50823
Written Test Application Form 2010 Payment Particulars Mode of Payment Payment Gateway Online ICICI
Date
Amount
Transaction ID.
22-09-09
1000
800824728
1. Full Name of Applicant:
ROHAN RAVI NAIR
2. Father's Name:
RAVI
3. Address
46/104 `A` WING, MANISH NAGAR, ANDHERI(W) MUMBAI MAHARASHTRA PIN: 400053 Email: [email protected] Phone: 022 26372203 Mobile: 9987933943
4. Date of Birth:
15-09-1989
5. Gender:
Male
6. Category:
General
7. Education status:
(Graduation) Appearing in the final exam / Awaiting for final year result
8. Discipline:
Others
Photo
9. Percentage at Graduation: 69.73 10. Percentage at PG:
N.A.
11. Choice of Test Centre:
MUMBAI (No change will be allowed. Right of allocation rests with IRMA.)
12. Work Experience:
0 month(s) (as on 31-7-09)
13. Programme applied for: Only PRM 14. Sponsored Candidate?:
No
15. Yearly Family Income:
3,00,001 to 4,50,000
16. State of Domicile:
Maharashtra
17. Source(s) of information about admission. IRMA Website 18. Declaration I declare that all the information contained in this form is correct. I shall provide documentary evidence, if required, wherever applicable. I understand that, if selected, my admission will be provisional; it will be confirmed only if I fulfil the eligibility criteria set for the admission. In the event of any false information appearing in this form or in the event of my failure to provide necessary certificates, my admission will stand automatically cancelled.
Date: _________________
Signature of Applicant:
Form No: 50823
Written Test Application Form 2010 Payment Particulars Mode of Payment Payment Gateway Online ICICI
Date
Amount
Transaction ID.
22-09-09
1000
800824728
1. Full Name of Applicant:
ROHAN RAVI NAIR
2. Father's Name:
RAVI
3. Address
46/104 `A` WING, MANISH NAGAR, ANDHERI(W) MUMBAI MAHARASHTRA PIN: 400053 Email: [email protected] Phone: 022 26372203 Mobile: 9987933943
4. Date of Birth:
15-09-1989
5. Gender:
Male
6. Category:
General
7. Education status:
(Graduation) Appearing in the final exam / Awaiting for final year result
8. Discipline:
Others
Photo
9. Percentage at Graduation: 69.73 10. Percentage at PG:
N.A.
11. Choice of Test Centre:
MUMBAI (No change will be allowed. Right of allocation rests with IRMA.)
12. Work Experience:
0 month(s) (as on 31-7-09)
13. Programme applied for: Only PRM 14. Sponsored Candidate?:
No
15. Yearly Family Income:
3,00,001 to 4,50,000
16. State of Domicile:
Maharashtra
17. Source(s) of information about admission. IRMA Website 18. Declaration I declare that all the information contained in this form is correct. I shall provide documentary evidence, if required, wherever applicable. I understand that, if selected, my admission will be provisional; it will be confirmed only if I fulfil the eligibility criteria set for the admission. In the event of any false information appearing in this form or in the event of my failure to provide necessary certificates, my admission will stand automatically cancelled.
Date: _________________
Signature of Applicant:
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