INSTITUTE OF PETROLEUM MANAGEMENT

PETROLEUM MANAGEMENT APTITUDE TEST( PMAT) 2006
TEST DATE: -- November 2006
ONLINE APPLICATION FORM
Personal Details Read important instructions carefully before filling form.
Salutation
First Name *
Middle Name
Last Name *
Date of Birth
Age as on September 30,2006
Years Months
Gender*
Father's/Mother's Name
Nationality
Address for Correspondence  
House No.Street No.
Area/Locality
City If other City,please specify
State If other State,please specify
Country If other Country,please specify
Pincode
In Case of Same Address
Permanent Address  
House No./Street No.
Area/Locality
City If other City,please specify
State If other State,please specify
Country If other Country,please specify
Pincode
Email Address  
Email : Alternate Email :
Contact Numbers  
Mobile (For Ex. +919876664554)
Residence (For Ex.+912234566543)
Office (For Ex.+912234566543)
Fax (For Ex.+912234566543)
Academic Background
Examination
University / Board
Degree Awarded
Principle Subjects Undertaken
Year of Passing
Grade / Division
Percentage
SSC
HSC
Graduation
Post Graduation
Any other
Current Employment Status
Employed
Self-employed
Currently not employed
If currently employed, details of the current employment
Current Designation
Name of the Employer
Employed Since
Total Professional Exposure
Full time Year   Months   Days  
Part time Year   Months   Days  
Prizes, Awards, Honours, Scholarships Received or Other Academic Distinctions:
(Please list those received post school education only)
 
Prizes, Awards, Honours or
Scholarships Received
Year
Accomplishment
Awarded by
Country/State
Activities And Interests:
 
Place list in order of importance any extra-curricular activity you are/have been involved with:
 
Duration
Activity
Role Played
Awards/Recognition
Country/State
   
PMAT Exam Center Code *
   
Select Bank for depositing payment * Account Number
       
       
Declaration:

I Accept the Declaration