Form No.

Affix a recent
[For office Use] passport size self
attested colour
photograph

NATIONAL INSTITUTE OF TECHNOLOGY, AGARTALA

P.O.: NIT Agartala, Jirania, Tripura (W)
Pin: 799046

APPLICATION FORM
(For admission in two years full time MBA Programme 2018 – 2019)
Registration Number [Office Use Only]: _______________________________________of year 2018- 2019.

SESSION – (2018 – 2019)

Read all instructions carefully before applying and tick in appropriate boxes . The print out of this application form properly filled
and signed by the applicant together with self attested photo copies of the certificates [including 10 th Admit Card] / mark
sheet of all examinations passed including CAT/CMAT/MAT/GMAT valid score card need to be sent to The Dean
(Academic Affairs),NIT Agartala on or before 27th March,2018 and softcopy of the completed application to be sent to the email
address(admission.som.nita@gmail.com) on or before 20th March,2018 . Incomplete Application Form without supporting
documents or Application Form received after the last date will be summarily rejected .
1. Write only one best possible valid score (As given in application) :
Registration SCORE Percentile /
EXAM No./ Roll No. SECURED/ Rank % below VALID TILL (Mandatory)
OBTAINED (Mandatory)
CAT
CMAT
MAT
GMAT
2. Valid score card is attached with application: Yes No
3. Name of the Applicant [In block Letters]:

4. Date of Birth:

D D M M Y Y Y Y

5. Nationality:

D D M M Y Y Y Y

6. Venue for PA (GD & PI)

1st Choice 2nd Choice

7. Gender [Tick the appropriate box]: Male Female Transgender

8. State to which the applicant belong:

9. Name of Father/Guardian:
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 10. Present Mailing Address:

State

PS

PIN

11. Permanent Address:

State

PS

PIN

12. Phone No (With STD Code) / Mobile No:

13. E-Mail [ It is mandatory for official communication]:

14. Whether the Applicant belongs to SC/ ST/ OBC / PH (Certificate as applicable, from the
competent authority, need to be attached)
General SC ST OBC PH

15.Primary Educational Qualification:

Exam Name of the Board/Council Year of Passing Percentage of

Passed School/College Marks

10th
10+2
16. Name of Degree of Qualifying Exam (Graduating Exam like B.Com, B.Tech,B.E, B.Sc.BBA etc)
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 _______________.
17. Duration of your graduation degree ?
2 yrs 3yrs 4yrs 5yrs

18. Is your graduation degree a full time regular course? Yes No

19. Are you a final year appearing graduate candidate? Yes No
20.Is your Graduation course “Yearly” or “Semesters” based? _____________.
21.Graduation Marks available till : Final Semester/Year or Till ______ Semester/Year.

22.Marks obtained in the Qualifying Examination based on latest available marks/grades

(Bachelor’s Degree). Use the top row only for each corresponding year in case of “yearly” based
exam.
Total Marks of
Marks/CGPA Percentage
Year of Passing Exam or Point Class/ Division
obtained of Marks@
Scale of CGPA
I Sem.
I Year
II Sem.

III Sem.
II Year
IV Sem.

V Sem.
III Year
VI Sem.

IV Year VII Sem.

VIII Sem.
@ Not applicable for CGPA. No conversion from CGPA to percentage or vice versa is allowed.
Note: For final year appearing candidate, original copy of certificate from the institute need to be submitted

23.Other Educational Qualification (if any):

Exam Name of the Board/Council/Uni Year of Passing Percentage of
Passed Institute versity Marks

24.Details of Industrial Experience, if any (Vocational Training will not be considered)

Name of From To Employed as Salary drawn
Employer

25. Total Duration of Work Experience:___________ Years and ________ months (Enclose an
experience certificate from the employer).

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 26. Extra –Curricular activity:

27. Whether the applicant is receiving any stipend / financial assistant for his study, If so give
details:____________________________________________________________________

28.Payment Details:
Demand Draft Number:

Name of the Bank:

Date of DD: D D M M Y Y Y Y

Amount paid (INR): 1000 500 [Tick the appropriate box]

29.Details of self attested photocopy of certificates/documents need to be attached along with this
form.[ Strikeout which is not applicable and tick in the appropriate box] :

Documents attached Yes No For office use

Verified Signature
(Yes/No)
1. Signed Print copy of application form.
2. Copy of the Marks/Grade Card of Qualifying Graduation
Exam ( both side of all years / all semesters)
3. Pass Certificate for Graduation Exam (not applicable for final
year appearing candidates).
4. Marks/Grade Card & Certificate for 10th & 12th Level Exam.
5. Score Card for CAT/CMAT/MAT/GMAT.
6. S.S.L.C./ X Std. Marks /Admit Card (for Date of Birth).
7. Certificate by employer ascertaining the duration of Work
Experience.
8. Caste Certificate issued by competent authority for SC/ST or
NC-OBC if applicable.
9. Certificate for the Physically Challenged, if applicable.
10. Original certificate for final year appearing candidates from
the institute signed and sealed by
Principal/HoD/Registrar/Director.
11. Any other (Specify)

30.Declaration by Applicant:

I hereby declare that the entries made in this application form are correct to the best of my knowledge and
belief. If selected for admission, I undertake to abide by the rules and regulations of the Institute as exist and
amended from time to time.

I note that the decision of the Institute is final in regard to selection for admission and venue for
personal assessment. The Institute shall have the right to take any action it deems fit, including expulsion,
against me at any time after my admission. If it is found that information furnished by me are false or
incorrect. I shall abide by the decision of the Institute, which shall be final.

Place :

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Date : Signature of the applicant

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