IN Maharashtra Govt Reg No.

F/36745

IIBMS

The Indian Institute Of Business Management & Studies

Application Form

Course Name: ________________________________________________

Specialization: ________________________________________________

Counselor Name: ______________________________________________

APPLICANT DETAILS I
Name:
(Surname) (First Name) (Middle Name)

D.O.B. Male Female

D D M M Y Y Y Y

Married: Unmarried: Nationality: _____________

Father’s/Husband’s Name:

Mother’s Name:

Correspondence Address:

P I N :

Permanent Address:

P I N :

Tel. No.: (M)

(R) with STD Code

(O)

E-mail:

Alternate E-mail:
 IN

IIBMS The Indian Institute Of Business Management &Studies

Academic Details:

Qualification Board/University Passing Year/Month Grade/Class Specialization if any

Work Experience: (Starting with recent experience)

Company Name City/state Designation From

Year/Month To Year/Month Remarks

Exam Option: From Home: Study Center: E-mail:

Fee Paid: Rs. ____________ Cash/D.D./Cheque/C.C. No.: ______________________

Bank: _______________________________________________________________

Declaration by Applicant: I declare that I have understood the course aspects and norms of
Indian Institute of Business Management and Studies. I assure to abide by the
conditions and standards of the institute. I am fully aware that if I am found violating any
conditions then my admission may be cancelled and I will be entirely responsible for it. I
have followed the instructions for application:

 Photocopy of Mark sheets and certificates in proof of all examination passed must be attached.
 The application form along with the bank Draft should be sent to the Institute though Courier/Speed Post.
 For more than one application photocopy of this application form may be used.
 Fees once paid is non refundable under any circumstances.

Date: ______________ Signature: ________________