ADMINISTRATIVE STAFF COLLEGE OF INDIA
POST GRADUATE IN HOSPITAL MANAGEMENT

(Approved by AICTE)

Instructions : Please use BLOCK letters to fill-in the application form. Please enclose Demand Draft for Rs. 1,000/- (Rupees one thousand only) in favour of `Administrative Staff College of India ' payable at Hyderabad. Candidates are required to qualify in CAT*/CMAT/GMAT/MAT/XAT/ATMA/Other exams(as per AICTE). Shortlised candidates will be notified of the dates and venue for Personal Interview.

Qualifying Examination
Attach attested copy of Score Sheet
Choice of PI Centre
Education (Please enclose attested copies of the certificates / testimonials)
Particulars Qualification Name of Board / Institution/ University Year of Study From To Division /Percentage Attested Copy
SSC / CBSE / ICSE (10th)
Intermediate HSC / 12th
Graduation
Post Graduation/ Other (Specify)
Work Experience (If any) Add More
Name of the Organization Designation / Job Description Reporting to Period From Period To
Details of Demand Draft attached

ASCI Fees can also be paid through DD or NEFT ( Online transfer). For paying by NEFT please refer to the bank details provided. If the payment is being made online, please mentioned the transaction id in place of "DD Number" in the above section and do mention "Online Transfer" along with the Bank Name in the "Drawn on Bank" field.

Bank Name : State Bank of Hyderabad
Address : 6-3- 1092, Ist floor, A Block, Raj Bhavan Road Branch, (Bellavista), Hyderabad – 500 082
Beneficiary Account Name : Administrative Staff College of India
Savings Bank Account Number : 62090698675
Bank MICR Number : 500004008
NEFT IFSC Code : SBHY0020063

DECLARATION

I hereby declare and certify that the information furnished in this application form is true to the best of my knowledge. I have not been disqualified by any University from appearing for any examination or from seeking admission to any progrmme of study. If admitted, I agree to abide by the Rules and Regulations of ASCI.

Completed / Filled-in Application Form, Demand Draft, Certificates / Testimonials and Score Sheets duly attested by a Gazetted Officer should be sent to :

The Director
Centre for Healthcare Management
Administrative Staff College of India
College Park Campus, Road No. 3,
Banjara Hills, Hyderabad - 500 034.
Phone : 040-66720713 / 66720712, Fax : 040-66720725
E-maill : pgdhm@asci.org.in