Program applying for:   
Name of the Candidate:    
Date of Birth:      
Mode of Personal Interview:   
Mailing Address
House Number:       
Personal E-Mail (which you access on daily basis):      
Re-type your Email address:      
Landline Phone no with STD code:  
Mobile No:      
Academic Qualification
Class X
Name of School:    
Year of Passing:      
Percentage of Marks Obtained (##.#)    
Mode of Study:   
Class XII
Name of School:    
Year of Passing:      
Percentage of Marks Obtained (##.#)    
Mode of Study:   
Work Experience (As on January 2017), If Any
Total No. Work Experience: (in Months)    
Parent's Details
Father's Name:    
Mother's Name:    
Parent's/Alternate Mobile:      
Test Details (if any), not mandatory
CAT Reg. No:   Qualifying Year:  
GMAT ID:   Qualifying Year:  
Candidate needs to take either of these tests for final selection.
IELTS Score:  
Qualifying Year:  
TOFEL Score:  
Qualifying Year:  
How did you learn about IMT Dubai MBA
Are you Consultancy
Login Details
Re-type Password:      
Undertaking by Candidate
I have gone through the prospectus and the Rules & Regulations of the Institute. I declare that all the above information provided by me on this application form and supporting documents are correct to the best of my knowledge and belief. In case of any change in the given information, I will notify the same to the institute immediately. If the information is found incorrect at any stage, I will be responsible for the same and the Institute may take action as deemed fit.

Instances of provision of incorrect information detected at any stage of the selection process will lead to disqualification of the candidate from the selection process and admission shall be cancelled by IMT. If such instances go undetected during the current selection process but are detected in subsequent years, such disqualification will take place with retrospective effect.