1. ADMISSION FORM - JULY 2013
Date:
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Please tick the program you are applying for:
o
Energy
o
Transportation
o & Gas)
MBA (Oil
BBA (Aviation Operations)
o
o
MBA (Power)
MBA (Aviation)
o
Affix
Photograph
MBA (Port
o & Shipping)
o
Infrastructure
o
MBA (Logistics & Supply Chain)
o
MBA (Infrastructure)
o
MBA (Health, Safety & Enviorment)
Personal Details:
IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please mention N/A wherever not applicable
1. Name (in Block Letters): ......................................................................................................................................................
2. Date of Birth: M M D D Y
Y
Gender
M
F
3. Correspondence Address: ....................................................................................................................................................
.....................................................................................................................................................................................................
........................................................................................................... Pin
4. Permanent Address: .............................................................................................................................................................
.....................................................................................................................................................................................................
............................................................................................................ Pin
5. Telephone (Res.):
Mobile:
6. Email: .....................................................................................................................................................................................
7. Nationality: ............................................................................................................................................................................
8. Occupation: ............................................................................................................................................................................
9. Name of the Company: .........................................................................................................................................................
10. Designation: .........................................................................................................................................................................
11. Employer’s Address: ...........................................................................................................................................................
.....................................................................................................................................................................................................
.....................................................................................................................................................................................................
12. Telephone (Off.):

2. Educational Qualifications
Stream/Degree
% & Grade
Year of Passing
Board/University
From
To
Class X
Class XII
Graduation
Post Graduation
Any Other
Work Experience
Designation
Name of the Organization
Years of Experience
From
To
Your interest in joining UPES?
.....................................................................................................................................................................................................
.....................................................................................................................................................................................................
.....................................................................................................................................................................................................
.....................................................................................................................................................................................................
Special Achievements
.....................................................................................................................................................................................................
.....................................................................................................................................................................................................
.....................................................................................................................................................................................................
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How did you hear about us?
o
Website
o
Newspaper
o
Emailer
oo
SMS
Magazine
o .......................................
Any Other
Declaration
I hereby state that the information given above is true to the best of my knowledge. In case any information is found to be incorrect, my candidature is liable to be
cancelled by the University. I shall abide by the rules and regulations of the University of Petroleum and Energy Studies, including dress code, and expected
behavioral norms in line with the University’s special charter. I shall ensure timely payment of all applicable dues.
Date:
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Student’s Signature

3. INFORMATION FORM FOR IDENTITY CARD
IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please fill in BLOCK LETTERS.
1. Name of the Program:
o
Energy
o
Transportation
o & Gas)
MBA (Oil
o
BBA (Aviation Operations)
o
MBA (Power)
o
MBA (Aviation)
o
Infrastructure
Affix
Photograph
o & Shipping)
MBA (Port
o
MBA (Logistics & Supply Chain)
o
MBA (Infrastructure)
o
MBA (Health, Safety & Enviorment)
2. Duration of the Program: July 1, 2013 to July 1, 2016
3. SAP ID (For Office use only):
4. Student’s Name (in English Capital Letters): .........................................................................
........................................................................................................................................................
5. Father’s Name: ......................................................................................................................................................................
6. Mother’s Name: .....................................................................................................................................................................
7. Correspondence Address: ....................................................................................................................................................
.....................................................................................................................................................................................................
........................................................................................................... Pin
8. Permanent Address: .............................................................................................................................................................
....................................................................................................................................................................................................
............................................................................................................ Pin
9. Telephone (Res.):
Mobile:
10. Telephone (Off.):
11. Emergency Contact No.:
12. Blood Group:
Authorized Signatory
Specimen Signature of the Student

4. INSTRUCTIONS FOR SENDING THE ADMISSION FORM
Please send the filled in Admission Form along with:
1. Non-refundable Admission Form fees of `1,000/- (through demand draft) in favor of “UPES”,
payable at Dehradun.
2. Xth & XIIth class certificates and mark sheets (photocopies should be self attested).
3. Graduation certificate & mark sheets (photocopies should be self attested).
4. Any other degree/diploma/certificate (as mentioned in the application form).
5. 2 passport size photographs affixed on the form.
6. Work experience certificate(s).
7. Completed ID form.
All these documents should reach us at the earliest at the following address:
K.K. Bhatnagar
Associate Director (Marketing)
Centre for Continuing Education
kbhatnagar@upes.ac.in
University of Petroleum & Energy Studies
Marketing & Communication Office
PHD Chamber of Commerce & Industry
3rd Floor, PHD House, 4/2, Siri Institutional Area
August Kranti Marg
NEW DELHI – 110 016
Tel: +91-11-41730151-53
Fax: +91-11-41730154
www.cce.upes.ac.in