IIBM Institute of Business Management
M.O.: IIBM India 21, Paharpur Business Center, Nehru Place, New Delhi-19 Campus 1 : IIBM Tower, 1 Beripura, Near Era Mall, Delhi Road, Meerut 250002 (NCR) Campus 2 : IIBM Tower, B 319, Pocket-B, Sec-1, Near Presidency School Shatabdi Nagar, Meerut 250002 (NCR) Tel : (Campus 1) 0121-4054591/92/93/94 (Campus 2) 011-32310200,32314235
PLEASE FILL COMPLETE FORM IN BLOCK LETTERS
Counsellor Name
ADMISSION FORM
Student Category
INDIAN
NRI/INTERNATIONAL
Affix Passport Size 4 Photos (Attach Extra Copies with this form for ID Card) & Office Use
(Mr./Ms./Dr.)
(First Name) (Middle Name)
(Last Name)
Date of Birth:
Gender:
MALE
FEMALE
Correspondence Address (Please mention the address where you would like to receive your Study Material)
Address: City: State: Country: Tel.: Mobile Email:
Alternate E-mail :
Pin Code : S T D
Do not begin with zeros
Permanent Address (Please fill if different from Corresondence Address or write 'SAME AS ABOVE')
Address:
City: State: Country: Tel.: S T D Pin Code: Mobile
Do not begin with zeros
Your Current Organization Details
Name of the Organization Total Service (Years) Current Designation:
Academic Details (Highest Educational Qualification Only)
Examination Board / University Year of Passing Discipline Class / Division % Marks
Course Enrolled (Please refer to the Information Brochure or ask your Counsellor) Course Name: Specializations 1: Specializations 2: Opted for Fast Track: Examination Method: Payment Method: Mode of Payment: Particulars
Lumpsum / Ist Installment IInd Installment IIIrd Installment Examination Fees Service Tax
Yes Postal Based Lumpsum DD/Cheque
No Email Based Installment Online Transaction Cash Deposit Centre Based
Amount
DD/Cheque
Date
Bank
Self Attested photo copy of following Documents Attached herewith (Please Tick) : Graduation 3rd Year Marksheet / Diploma 4 Photographs Experience Certificate Certificate of Undertaking
CV
I have carefully read the rules and regulations as given in this Application and agree to abide by the same. I understand these rules are only indicative and may be modified/changed/revised from time to time. I agree not to countermand and to honor all the post dated cheques enclosed by me towards the Installment Facility. I understand that in case I withdraw from the program I will not be entitled to claim any refund of amount paid. I agree that I will settle the amount with IIBM whether or not I continue in the program, I understand the Jurisdiction for all disputes (if any) relating to the Institute is only/exclusively Meerut, Uttar Pradesh. I hereby declare that the information provided by me in the Application is true and correct to the best of my knowledge. My signature below certifies that I have read understood and agree to the rules and regulations, including Legal Aspects and my financial responsibilities.
Place: ..............................
Date: ...........................
Signature of Applicant ..............................................
Rules and Regulation of the Institute
1. The Director of the Institute reserves the right to accept or reject an application without assigning any reason whatsoever. 2. The necessary fee to be paid by DD would be drawn in favour of IIBM Institute of Business Management Payable at New Delhi/Meerut will have to be sent along with the filled up application form. 3. Allotment of examination centre in a particular place will be at the discretion of the Board of Examinations of the Institute which reserves the right to cancel any centre if there is insufficient number of students. 4. The Management of IIBM reserves the right to change the course details without notice as per the prevailing conditions. 5. IIBM courses are industry endorsed certificate courses and are not recognized by UGC & AICTE. 6. Service Tax 12.36% is applicable on all the course of IIBM.
Issue Date 1/08/2012
