VPM's Dr. V. N. Bedekar Institute of Management Studies online admission form :

Vidya Prasarak Mandal’s
Dr. V. N. Bedekar Institute of Management Studies
(Dr. V. N. BRIMS)
’Jnanadweepa’, Chendani Bunder Road Thane (MS) India. 400601
Tel: No. (91-22) 2536 4492, 2536 9868 Fax: (91-22) 2544 6554
email: vnbrims@vpmthane.org
Website: www.vpmthane.org

Application for Approved MSBTE Courses batch 2007 - 2008

Instructions :

Please complete the form fully. All fields marked with * are compulsory.
After verifying that you have filled the form correctly and fully, click on the submit button to submit the form. Please submit a form only once
Print the summary page presented to you on the next screen after clicking submit button.
This form will be considered for admission only if you have submitted the printout along with necessary document copies AND paid the form fees.
You can submit the form at the institute or can send the same along with a DD/Cash for Rs 250/- for Group Discussion/Personal Interview on or before 30th June 2007.

To,

The Director,
VPM's DR. VN BRIMS
Thane.

Dear Sir,

I hereby apply for admission to
i ) Two Year Full Time Post Graduate Advance Diploma in Business Management Sciences
ii) One Year Full Time Post Graduate Diploma in Pharmaceutical Business Management

Student Information :

Surname *

First Name *

Middle Name *

Correspondence Address Line 1 *

Correspondence Address Line 2

Correspondence Residence City *

Correspondence Pincode *

Correspondence Phone Number

Email Address *

Permanent Residence Address Line 1 *

Permanent Residence Address Line 2

Permanent Residence Address City *

Permanent Residence Address Pincode *

Permanent Residence Address Phone Number

Parent's Office Address Line 1

Parent's Office Address Line 2

Parent's Office Address City

Parent's Office Address Pincode

Parent's Office Address Phone Number

Date of Birth *

dd-mm-yyyy format only. Example 29-12-1971

Birth Place District & State*

Rural / Urban *

Rural or Urban

Gender *

Male or Female

Married ? *

Married / Un-Married / Widow(er) / Divorcee

Nationality *

Father's / Husband's / Mother's Name *

Father's / Husband's / Mother's Occupation *

Place :

Date :

Signature

ACADEMIC PROFILE *

i) Basic Degree *
( To be taken as Qualifying Examination)

Appeared* / Passed

ii) Name of the University *

State*

iii) Details of examinations passed (Matriculation & above)
Name of Exam or Course
S. S. C. / I. C. S. E. / C. B. S. E. *	Board / University *
	School / College *
	Year of Passing *	mm-yyyy format only. Example 09-1999
	Marks Obtained *
	Marks Outof *
	% *	e.g. 80.00, 79.87 etc
	Remarks
H. S. C. / I. S. C. *	Board / University *
	School / College *
	Year of Passing *	mm-yyyy format only. Example 09-1999
	Marks Obtained *
	Marks Outof *
	% *	e.g. 80.00, 79.87 etc
	Remarks
B.A. / B.Com. / B.Sc. / B.E./ B.Pharm *	Board / University *
	School / College *
	Year of Passing *	mm-yyyy format only. Example 09-1999
	Marks Obtained *
	Marks Outof *
	% *	e.g. 80.00, 79.87 etc
	Remarks
Post Graduate Degree / P. G. Dimploma	Board / University
	School / College
	Year of Passing	mm-yyyy format only. Example 09-1999
	Marks Obtained
	Marks Outof
	%	e.g. 80.00, 79.87 etc
	Remarks

WORK EXPERIENCE : Full Time / Part Time

	Current Job	Previous Job
Organisation
Designation
Full / Part Time
Period	From To	From To
Duration	Yrs Month	Yrs Month
Duration Total Yrs.	Yrs Month
Salary P.A.

Instructions :

Student Information :

ACADEMIC PROFILE *

Please verify the correctness of the data before clicking submit.