TEZPUR UNIVERSITY
NAPAAM, TEZPUR - 784028, ASSAM
APPLICATION FORM Paste one recent passport
MBA (Full-time) Programme 2014-15 size photograph
Applying Through
(Please tick whichever is applicable)
CAT MAT Both
(Read the prospectus carefully before filling in the Form)
For other than SC / ST Category
Date Month Year Place
Male Female Single Married
To be submitted to the Head of the Department Department of Business Administration on or before the specified date
For office use only
Selected provisionally under
Gen / OBC-NCL / PWD
category
Head of the Department
Admitted /
provisionally admited
Controller of Examinations
1. a) Programme applied for MBA (Full-time)
2. Name in full (Block Letters)
3. a) i) Father’s/Husband’s Name
ii) Occupation
b) i) Mother’s Name
ii) Occupation
a) i) ......................................................................................................
ii) ......................................................................................................
b) i) ......................................................................................................
ii) ......................................................................................................
4. Guardian’s Name & Address
with contact number(s)
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Pin : ............................................... E-mail : ...................................................
Phone No (with STD code): .............................................................................
5. Correspondence Address and contact number(s)
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Pin : ............................................... E-mail : ...................................................
Phone No (with STD code): .............................................................................
6. Permanent Address and contact number(s)
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Pin : ............................................... E-mail : ...................................................
Phone No (with STD code): .............................................................................
7. CAT /MAT Registration Number CAT Registration No.
MAT Form No.
Person with disability
(PWD)
Kashmiri Migrant
(KM)
Minority Community
10. Category (Please tick )
(b)
Gen SC ST OBC-NCL
11. Gender (Please tick) 12. Marital Status(Please tick)
(a)
(c) Religion:

8. Date & place of birth 9. Nationality State of Domicile
13. Hostel Accommodation is required (Please tick)
Yes No

A candidate can apply through both CAT & MAT

14. Are you willing to be considered under SSS (For details, please refer to page 12 of the prospectus Yes No
15. Blood Group (Optional Please tick