The document is an application form for admission to the 48th Post Graduate Diploma in Co-operative Business Management (PGDCBM) at the Vaikunth Mehta National Institute of Co-operative Management, Pune. It requires personal and professional details, including the applicant's name, designation, sponsoring organization's name, academic qualifications, and work experience. The form also includes a section for the sponsoring authority to confirm their endorsement of the applicant.

1. Ìãõ‡ãŠâìŸ ½ãñÖ¦ãã ÀãÓ›Èãè¾ã ÔãÖ‡ãŠãÀãè ¹ãƺãâ£ã ÔãâÔ©ãã¶ã, ¹ãì¥ãñ ãäÌã²ãã¹ããèŸ ½ããØãÃ, ¹ãì¥ãñ 411 007
VAIKUNTH MEHTA NATIONAL INSTITUTE OF COOPERATIVE MANAGEMENT,
PUNE 411 007
48 Ìãñâ ÔãÖ‡ãŠãÀãè ̾ãÌãÔãã¾ã ½ãñâ Ô¶ãã¦ã‡ãŠãñ¦¦ãÀ ¹ãªãäÌã‡ãŠã (¹ããè.•ããè.¡ãè.Ôããè.ºããè.†½ã.) ½ãñâ ¹ãÆÌãñÍã Öñ¦ãì ‚ããÌãñª¶ã ¹ãŠã½ãÃ
APPLICATION FORM FOR ADMISSION TO
48th POST GRADUATE DIPLOMA IN CO-OPERATIVE BUSINESS MANAGEMENT (PGDCBM)
1. ‚ããä£ã‡ãŠãÀãè ‡ãŠã ¶ãã½ã (ºã¡ñ ‚ãàãÀãñâ ½ãñ) : Ñããè / Ñããè½ã¦ããè: _________________________________________
Name of the Officer (In Block letters) Shri / Smt.
2. ¹ãª¶ãã½ã / Designation : _______________________________________
3. ¹ãÆã¾ããñãä•ã¦ã ‡ãŠÀ¶ãñ ÌããÊãñ ÔãâØ㟶㠇ãŠã ¶ãã½ã Ìã ¹ã¦ãã :____________________________________
Name and Address of the Sponsoring
Organisation _____________________________________________________
4. ¹ã¨ããÞããÀ ‡ãŠã ¹ã¦ãã/Postal Address: __________________________________________________
___________________________________________________
__________________________________________________
ãä¹ã¶ã ‡ãŠãñ¡ /Pin Code _________ À㕾ã/State : _____________________
ªìÀ¼ããÓã /Phone:_______________________________________
¹ãŠõ‡ã‹Ôã / Fax :________________________________________
ƒÃ-½ãñÊã /E-mail:_______________________________________
ÌãñºãÔãホ / Website: www.______________________________
5. ‚ããÌããÔããè¾ã ¹ã¦ãã / Residential Address : ______________________________________________
_________________________________________________
ãä¹ã¶ã ‡ãŠãñ¡ /Pin Code _________ À㕾ã/State : _____________________
½ããñºããƒÃÊã ÔãâOE¾ãã ªîÀ¼ããÓã
Mobile No. +91____________ Land Line ________________
6. •ã¶½ããä¦ããä©ã / Date of Birth :______/_____/19_______ „½ãÆ /Age _________YRS
(DD/MM/YYYY)
7. ¹ããÔã¹ããñ›Ã •ãã¶ã‡ãŠãÀãè/Passport Details : ¹ããÔã¹ããñ›Ã ‡ãÆŠ½ããâ‡ãŠ / Passport No. _______________________
•ããÀãè ‡ãŠÀ¶ãñ ‡ãŠãè ¦ããÀãèOEã / Date of Issue _________________
Ôã½ããã书㠇ãŠãè ¦ããÀãèOEã / Date of Expiry ___________________
8. Íãõàããä¥ã‡ãŠ ¾ããñؾã¦ãã :
Academic Qualification :
„¦¦ããè¥ãà ¹ãÀãèàãã ‡ãŠã ¶ãã½ã
Name of Exam Passed
ãäÌãÍÌããäÌã²ããÊã¾ã / ºããñ¡Ã
University / Board
¹ãÀãèàãã „¦¦ããè¥ãà Öãñ¶ãñ ‡ãŠã ÌãÓãÃ
Year of Passing
¹ãÆ㹦ããâ‡ãŠ
Marks Obtained
1. Ô¶ãã¦ã‡ãŠ / Degree
2. ¹ãÀãÔ¶ãã¦ã‡ãŠ
Post-Graduation
3. ‚㶾㠇ãŠãñƒÃ/Any other
(‡ãŠð¹ã¾ãã Ô¶ãã¦ã‡ãŠ ¹ãƽãã¥ã¹ã¨ã ‡ãŠãè Ô㦾㠹ãÆãä¦ã¾ããùâ ¼ãñ•ãñ) (Please send true copies of the degree certificates)
...2

2. : 2 :
9. ̾ããÌãÔãããä¾ã‡ãŠ ¾ããñؾã¦ãã
Professional Qualifications :
10. ‡ãŠã¾ããöãì¼ãÌã / Work Experience :
ÔãâØ㟶㠇ãŠã ¶ãã½ã
Name of the
Organisation
¹ãª ãä•ãÔã¹ãÀ ‡ãŠã¾ãÃãä‡ãŠ¾ãã
Post held
‡ãŠã¾ãà ‡ãŠãè ¹ãƇãŠðãä¦ã
Nature of work
‡ãŠºã Ôãñ
From
‡ãŠºã ¦ã‡ãŠ
To
11. Ìã¦ãýãã¶ã Ìãñ¦ã¶ã (¹ãÆãä¦ã½ããÖ) / Present Pay (per month):
i) ½ãîÊã Basic (Rs.) ____________________________
ii) ¼ã¦¦ãñ Allowance (Rs.) ____________________________
iii) ‡ãŠìÊã Ìãñ¦ã¶ã Total pay (Rs.) _____________________________
¾ããäª ¹ãÆÌãñÍã Öñ¦ãì Þã¾ã¶ã ãä‡ãŠ¾ãã Øã¾ãã ¦ããñ ½ãõâ ÔãâÔ©ãã¶ã ‡ãŠñ ãä¶ã¾ã½ããñâ ¦ã©ãã ãäÌããä¶ã¾ã½ããñâ ‡ãŠã ¹ããÊã¶ã ‡ãŠÁâØãã ý
If selected, I will abide by the rules and regulations of the Institute.
ã䪶ããâ‡ãŠ
Date : (‚ããÌãñª‡ãŠ ‡ãŠã ÖÔ¦ããàãÀ)
Ô©ãÊã (Signature of the Applicant)
Place:
Ñããè/ Ñããè½ã¦ããè____________________________________ ƒÔã ÔãâØ㟶ã/ÔãâÔ©ãã¶ã/ãäÌã¼ããØã ½ãñâ
______________ Ôãñ ‡ãŠã¾ãÃÀ¦ã Öõ ý „¶ã‡ãŠãñ ¦ããè¶ã ÔããÊã Ôãñ ‚ããä£ã‡ãŠ ãäÌããä¼ã¸ã ¹ãªãò ¹ãÀ ‡ãŠã¾ãà ãä‡ãŠ¾ãã Öõ ý ƒÔããäÊㆠ„¶ã‡ãŠãñ
1 ‚ã‡ã‹›îºãÀ, 2014 Ôãñ ÍãìÁ Öãñ¶ãñ ÌããÊãñ ÔãÖ‡ãŠãÀãè ̾ãÌãÔãã¾ã ¹ãƺãâ£ã¶ã ½ãñâ Ô¶ãã¦ã‡ãŠãñ¦¦ãÀ ¹ãªãäÌã‡ãŠã (¹ããè.•ããè.¡ãè.Ôããè.ºããè.†½ã.) ½ãñâ
¹ãÆÌãñÍã Öñ¦ãì ¶ãããä½ã¦ã ãä‡ãŠ¾ãã •ãã¦ãã Öõ ý
Shri/Smt ___________________________________________, is working in this Organisation /
Institution/Department as _______________________ since ___________. He/She has put in more
than three years of service in various capacities. His/her candidature is, therefore, sponsored for
admission to Post Graduate Diploma in Co-operative Business Management (PGDCBM) commencing
in 1st October, 2014.
ã䪶ããâ‡ãŠ Date : (¹ãÆã¾ããñãä•ã¦ã ‡ãŠÀ¶ãñÌããÊããè ÔãâÔ©ãã ‡ãŠñ Ôãàã½ã ‚ããä£ã‡ãŠãÀãè ‡ãŠã ½ãîÖÀ ÔããäÖ¦ã ÖÔ¦ããàãÀ)
Ô©ãÊã Place : Signature of the sponsoring authority with seal