School of Management Form

Application No:
HITSCAT/SOM/2024/MBA/24186614

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Course Preference
Select Program 1 MBA Select Course 1 LOGISTICS MANAGEMENT Shift Preference 1
Select Program 2 MBA Select Course 2 HOSPITAL MANAGEMENT Shift Preference 2
Select Program 3 MBA Select Course 3 FINANCE, MARKETING AND HR Shift Preference 3

Exam Preference
Preferred Exam State 1 Preferred Exam Center 1
Preferred Exam State 2 Preferred Exam Center 2

Applicant Details
Your Nationality : INDIAN Have you studied in India? YES
How Did You Come To Know GOOGLE SEARCH HINDUSTAN
Social Media
About Hindustan? WEBSITE
Select Online Advertisement Alumini Name
Alumini Department Alumini Year
School Teacher Name School Name
Exhibition Stall Name Exhibition Stall Place
Coaching Center Name Coaching Center Place

Personal Details
Name of the Student MR SIVASUBRAMANIAN K
Mobile Number +91-9345284626 Email ID KSIVASUBRAMANIAN251@GMAIL.COM
Date Of Birth 12/02/2003 Age as on 31 August 2024 21 YEARS , 6 MONTHS , 19 DAYS
Gender MALE Blood Group A+
Place of Birth Home Phone Number
Religion HINDU Mother Tongue TAMIL
Social / Community Category BC Aadhaar Number 301993992350
Are you disabled? NO Nature of Deformity

Parent's Details
Father Details Mother Details Guardian Details
Name MR S KUTHALINGAM MRS K MAHALAKSHMI
Mobile Number +91-9345284626 +91-9345284626
Email ID KSIVASUBRAMANIAN251@GMAIL.COM KSIVASUBRAMANIAN251@GMAIL.COM
Education Qualification OTHER|10 OTHER|10
Occupation OTHER|EMPLOYEE HOUSE WIFE
Designation -
Organization Name
Organization Address
Annual Income 1L - 5L
Income: Any Other Source NO
Income Source1 Income Value1
Income Source2 Income Value2

Address Details
Communication Address Permanent Address
Country INDIA INDIA
State TAMIL NADU TAMIL NADU
District TIRUNELVELI TIRUNELVELI
City TENKASI TENKASI
Pincode 627811 627811
Address 60,SOUTH OPANAI STREET TENKASI 60,SOUTH OPANAI STREET TENKASI

Educational Details
Year of Obtained
Name of Stream/Major
Board/University Passing Result Status Marking Scheme Percentage/C
School/College Subjects
(YYYY) GPA
VEERAMAMUNIVAR TAMIL NADU BOARD OF
10th R C HR SECONDARY SECONDARY SCIENCE 2018 - PERCENTAGE 75
SCHOOL EDUCATION
TAMIL NADU BOARD OF
VEERAMAMUNIVAR
12th HIGHER SECONDARY COMMERCE 2020 DECLARED PERCENTAGE 68
R C HR SEC SCHOOL
EDUCATION
MANONMANIAM
J P COLLEGE OF
Graduation SUNDARNAR BCOM 2023 DECLARED CGPA OUT OF 10 8
ARTS AND SCIENCE
UNIVERSITY
Post
Graduation
Any other
qualification

12th School Address 12th School State 12th School District Place

10th Subject Details

Subjects Marks Obtained out of % of Marks
1
2
3
4
5
6
7
8

12th Subject Details

Subjects Marks Obtained out of % of Marks
1
2
3
4
5
6
7
8
9
Entrance Exam Details
Name of the Exam (eg. CMAT, MAT
Registration Number Date of Appearing (DD/MM/YYYY) Total Percentile Obtained Total Score
CAT,XAT etc.)

Work Experience (If Any)

Work Experience (If Any, Start from current to previous ones)
Name of the Company Duration Designation Nature of Work
1.
2.

Hobbies / Extra - Curricular Activities

Hostel Details
Do You Require Hostel Accommodation? NO Do You Require College Transport (For Days scholars only) ? NO

Payment Details:
Transaction ID pay_O5z6HKSnL25Uxi Mode of Payment Online
Payment Method Online Payment Date 03/05/2024

Declaration
• I HEREBY DECLARE THAT ALL PARTICULARS STATED BY ME IN THE APPLICATION ARE TRUE AND CORRECT. IF ANY INFORMATION FURNISHED
BY ME IS FOUND TO BE FALSE OR DISTORTED OR IF ANY INFORMATION IS FOUND TO BE SUPPRESSED TO SECURE ADMISSION, I UNDERSTAND
THAT I WILL BE DENIED ADMISSION AND IF ALREADY ADMITTED, MY ADMISSION/DEGREE ACQUIRED IS LIABLE TO BE CANCELLED WITHOUT
ANY CLAIM OR CONSIDERATION. • I SHALL STRICTLY ABIDE BY THE RULES AND REGULATIONS OF THE IN
• I SHALL STRICTLY ABIDE BY THE RULES AND REGULATIONS OF THE INSTITUTION. I HAVE READ AND UNDERSTOOD THE COLLEGE
RULES/REFUND POLICY/ANTI-RAGGING POLICY AND I HEREBY DECLARE THAT I WILL NEVER INVOLVE MYSELF IN ANY ILLEGAL
ACTIVITIES/RAGGING ACTIVITIES.
Applicant Name SIVASUBRAMANIAN K Parent Name S KUTHALINGAM Date 03/05/2024
INSTITUTE WILL REVIEW YOUR DOCUMENTS, ELIGIBILITY CRITERIA AND WILL GRANT THE APPROVAL FOR PAYING TOKEN FEE.
 FOR OFFICE USE ONLY

Eligibility (%):

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Admission Counselor

Fees:

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Signature
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Head Admissions
Name of the candidate: Course:

Date Receivable Received

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Deputy Director (Admissions) Registrar