application form iibm institute 14.3.2014

8/10/2019 Application Form IIBM Institute 14.3.2014

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A

DMISSION

FORM

IIBM Institute of Business ManagementM.O.: IIBM India 21, Paharpur Business Center, Nehru Place, New Delhi-19Campus 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 : (Admin Office) 0121-4054591/92/93/94 (Marketing Office) 011-32310200, 011-65151770

PLEASE FILL COMPLETE FORM IN BLOCK LETTERS

Counsellor Name

Student Category INDIAN NRI/INTERNATIONAL

(Mr./Ms./Dr.) (First Name)

(Middle Name)

(Last Name)

Affix Photos

(Attach 4 ExtraCopies with thisform for IDcard& Office Use)

Date of Birth: d d m m y y y y Gender: MALE FEMALE

Correspondence Address (Please mention the address where you would like to receive your Study Material)

Address:

City:

State:

Country

: Tel.: S T D

Do not begin with zeros

Pin Code:

Mobile

Email:

Alternate E-mail:

Permanent Address (Please fill if different from Correspondence Address or write 'SAME AS ABOVE')

Address:

City:

State:

Country:

Tel.: S T DDo not begin with zeros

Pin Code:

Mobile

Your Current Organization Details

Name of the Organization

Total Service (Years) Current Designation:


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ADMISSI

ON

FORM

Academic Details (Highest Educational Qualification Only)

Examination Board / University Year of Passing Discipline Class / Division % Marks

Course Selected: (Please refer to the Information Brochure or ask your Counsellor)

Dual Certi fi cation Program:

Post Graduate Diploma in Management+ Master Program in Business Administration 2 Years

Management Certi fi cation Programs:

Master Program in Business Administration - 1 Year

Master Program in Business Administration - 1 Year + 3 Certifications

Master Program in Business Administration - 2 Year

Master Program in Business Administration - 2 Year + 3 Certifications

Executive Master Program in Business Administration - 1 Year

Executive Master Program in Business Administration - 1 Year + 4 Certifications

Certified Manager - 6 Months

Associate Certified Manager - 6 Months

Certified Manager + 3 Certifications - 6 Months

Associate Certified Manager + 3 Certifications- 6 Months

Diploma Programs:

Diploma in Business Administration - 6 Months

Advance Diploma in Business Administration - 6 Months

I ntegrated Certi fi cation Programs:

Diploma in Business Administration + Master Program in Business Administration - 1 Year

Diploma in Business Administration + Master Program in Business Administration - 1 Year + 3 Certifications

Diploma in Business Administration + Master Program in Business Administration - 2 Year

Diploma in Business Administration + Master Program in Business Administration - 2 Year + 3 Certifications

Diploma in Business Administration + Executive Master Program in Business Administration - 1 Year

Diploma in Business Administration + Executive Master Program in Business Administration - 1 Year + 4

Certifications

Post Graduate Certi fi cation Programs:

Post Graduate Diploma in Business Management- 2 Years

Executive Post Graduate Diploma in Business Management-1 Year

Specialization 1:

Specialization 2:

Opted For Fast Track: Yes No

Examination Method: Postal Based Email Based Centre Based


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ADMISSION

FORM

Payment Method: Lumpsum Installment

Mode of Payment: DD/Cheque Online Transaction Cash Deposit

Course Fee:

Particulars Amount DD/Cheque Date Bank

Lumpsum / Ist Installment

IInd Installment

IIInd Installment

Examination Fee

Service Tax

Self Attested photo copy of following Documents Attached herewith (Please Tick):

Graduation 3rd Year Marksheet / Diploma 4 Photographs Experience Certificate CV

Certificate of UndertakingI 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

LegalAspectsand my financial responsibilities.

Place: .......................... Date: ......................... Signature of Applicant: ..................................

Rules and Regulation of the Institute1. 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 ofIIBM Institute of Business ManagementPayable 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 Institute of Business Management is NOT a university & hence none of our courses lead to degrees.

6. IIBM courses are industry endorsed certificate courses.

7. Service Tax of 12.36% is applicable on all the course of IIBM.

STC-Issue Date 27/02/2014