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*INSTRUCTIONS BEFORE FILLING THE APPLICATION
1. A D.D. for Rs. 1200/- payable at Hyderabad in favor of "Siva Sivani Institute of Management" must be taken if intending to pay by DD.
2. Applicant can also pay by credit / debit card using online payment option.
3. All fields marked * - are mandatory
4. Print the Acknowledgement slip found after submitting the application and attach it along with the DD sent to SSIM if paid by DD.
5. Login to www.ssim.ac.in with the access credentials sent to your email address to Print Hall ticket.
6. Paste your recent photograph on the space provided on Hall ticket.
7. Carry all your copies of marks memos and the qualifying exams score card to GD/ Interview.

Application Form

ADMISSION

* Batch year 2014
* Type of Program Residential Non - Residential
* Course Applied
* Preferred GD Place
* Preferred GD Date The GD Date will be intimated by SSIM shortly.

PERSONAL DETAILS

Last Name (Surname) :
* Applicant Name
* Name of the Father/Guardian:
Name of the Mother:
* Date of Birth:
* Gender: Male Female
CONTACT ADDRESS
Address Line1: Address Line2:
City: State:
Country: Pincode:
* Student Email ID: Student Mobile No:
* Confirm Email ID: Pass Port No:
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EXAM DETAILS

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Entrance Exam Appeared
CAT CAT Registration No: CAT Composite Score: CAT Percentile:
XAT XAT Registration No: XAT Composite Score: XAT Percentile:
MAT (SEP 13) MAT (SEP 13) Registration No: MAT (SEP 13) Composite Score: MAT (SEP 13) Percentile:
MAT (DEC 13) MAT (DEC 13) Registration No: MAT (DEC 13) Composite Score: MAT (DEC 13) Percentile:
MAT (FEB 14) MAT (FEB 14) Registration No: MAT (FEB 14) Composite Score: MAT (FEB 14) Percentile:
MAT (MAY 14) MAT (MAY 14) Registration No: MAT (MAY 14) Composite Score: MAT (MAY 14) Percentile:
CMAT (SEP 13) CMAT (SEP 13) Registration No: CMAT (SEP 13) Composite Score: CMAT (SEP 13) Percentile:
CMAT (FEB 14) CMAT (FEB 14) Registration No: CMAT (FEB 14) Composite Score: CMAT (FEB 14) Percentile:
GMAT GMAT Registration No: GMAT Composite Score: GMAT Percentile:
ATMA ATMA Registration No: ATMA Composite Score: ATMA Percentile:
ICET ICET Registration No: ICET Composite Score/Marks: ICET Rank:

PARENT/ GUARDIAN OCCUPATION DETAILS

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Occupation of the Father/Guardian:
Profession : Self Employed Salaried(Govt.) Salaried(Pvt.)
Name of the Employer/Business Net Monthly Income :
Mobile No: Email ID:
Parent Address
Address Line1: Address Line2:
City: State:
Country: Pincode:

SCHOOL/ + 2

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Examination Board / University Institution Marks(%) Year of completion Medium of Instructions
Class X
Intermediate / +2

GRADUATION

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Examination Board / University Institution Marks(%) Year of completion Medium of Instructions
Name of the Degree
Year 1
Year 2
Year 3
Year 4
Aggregate 'Degree' Percentage of Marks (Excluding final year marks if still pursuing)

POST GRADUATION

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Examination Board / University Institution Marks(%) Year of completion Medium of Instructions
Name of the Post Graduation (If any) (MCA/MSc/Mcom/MTech/Others):
Year 1
Year 2
Year 3
Aggregate 'PG' Percentage of Marks (Excluding final year marks if still pursuing)

EXPERIENCE

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Name and Address of Organisation Address Designation From Date To Date Period (Months) Salary

HOW DO YOU KNOW ABOUT SSIM ?

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I know SSIM through Internet News Paper Magazine Friends and Relatives Others(please specify)

PHOTOS AND DOCUMENTS

Upload Your Photo here : (Maximum File Size is 1 MB,
Formats Supported: jpg, png, gif, bmp, jpeg, JPG, PNG, GIF, BMP, JPEG)
Choose a zip file of certificates to upload : (Maximum File Size is 7 MB)

DECLARATION

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I declare that all the information furnished in this application form is correct to the best of my knowledge. I understand and agree that in the event of any information being found to be incorrect or false, I will be refused admission and/or I will be debarred from continuing the course in this Institute. I have read the promotional material, prospectus and gone through other relevant counseling information and understood the requirements for the admission and completion of the course and confirm that I will abide by the rules and regulations of the Institute that are in vogue from time to time, in all respects. I will comply with all rules of the Institute relating to discipline and ragging.
I Agree with the declaration mentioned above.
Payment Type: DD Online Payment ( Secure Payment through Credit Card/Debit Card(Approved by Master/Visa) )
DD Number: DD Date: Bank Name:
Receipt No:
Transaction No:
Cash: