PLEASE FILL COMPLETE FORM IN BLOCK L ET T E R S

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1 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 (NCR) Campus 2 : IIBM Tower, B 319, Pocket-B, Sec-1, Near Presidency School Shatabdi Nagar, Meerut (NCR) Tel : (Admin Office) /92/93/94 (Marketing Office) , Counselor Name PLEASE FILL COMPLETE FORM IN BLOCK L ET T E R S Student Category INDIAN NRI/INTERNATIONAL (Mr./Ms./Dr.) (First Name) Affix Photos (Attach 4 Extra Copies with this form for ID card & Office Use) (Middle Name) (Last Name) Date of Birth: d d m m y y y y Gender: MALE FEMALE ADMISSION FORM Correspondence Address (Please mention the address where you would like to receive your Study Material) Address: City: State: Country : Tel.: S T D Mobile Alternate Pin Code: Permanent Address (Please fill if different from Correspondence Address or write 'SAME AS ABOVE') Address: City: State: Country: Tel.: S T D Pin Code: Mobile: Your Current Organization Details Name of the Organization Total Service (Years) Current Designation:

2 Academic Details (Highest Educational Qualification Only) Examination Institute / Year of Passing Discipline Class / Division % Marks University Course Selected: (Please refer to the Information Brochure or ask your Counselor) Dual Program: Post Graduate Diploma in Management + Master Program in Business Administration 2 Years Management Certification Programs: Executive Program in Business Administration-11Month Executive Program in Business Administration + 4 Certification 11 Month ADMISSIONFORM Master Program in Business Administration- 11 Months Master Program in Human Resource Management 1Year Master Program in International Business Master Program in Supply Chain Management 11 Months Master Program in Business Administration + 3 Certification 11 Months Master Program in Business Administration 2 Year Master Program in Business Administration + 3 Certifications - 2 Year Executive Master Program in Business Administration 11 Months Executive Master Program in Business Administration + 4 Certifications 11 Months 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 Integrated Certification Programs: Diploma in Business Administration + Master Program in Business Administration 11 Months Diploma in Business Administration + Master Program in Business Administration + 3 Certifications 11 Months Diploma in Business Administration + Master Program in Business Administration 2 year Diploma in Business Administration + Master Program in Business Administration + 3 Certifications- 2 Year Diploma in Business Administration + Executive Master Program in Business Administration- 11 Months Diploma in Business Administration + Executive Master Program in Business Administration + 4 Certifications 11 Months Post Graduate Certification Programs: Post Graduate Diploma in Management 11 Months Post Graduate Diploma in Management + 3 certifications 11 Months

3 Post Graduate Diploma in Management + Certified Manager + Best Manager Award 11 Months Post Graduate Diploma Management + Certified Manager + 3 Certifications + Best Manager Award- 11 Months Post Graduate Diploma in Digital Marketing- 11 Months International Programs: Post Graduate Diploma in Management- IPMA, UK Master Program: Master Program in Computer Application - 11 Months Digital Marketing Specialist Certified Digital Marketing Master Program Bank PO Exam Preparation Course Search engine Optimization (SEO) Professional certification - 3 Month Web Analytics Professional Certification - 3 Month Content Marketing Professional - 3 Month Pay Per Click (PPC) Professional Certification 3 Month Social Media Professional Certification 3 Month ADMISSION FORM Mobile Marketing Professional Certification- 3 Month Online SSC/Bank PO /Clerk Preparation Staff Selection Commission Preparation Course - 11 Month Bank PO Exam Preparation Course Specialization 1: Specialization 2: Opted For Credit Based System: Yes No Examination Method: Online 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 GST 18% *Self Attested photo copy of following Documents Attached herewith (Please Tick): Graduation 3rd Year Marksheet / Diploma 4 Photographs Experience Certificate CV

4 Certificate of Undertaking 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 The Institute reserves the right to accept or reject an application without assigning any reason whatsoever. The necessary fee to be paid would be 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. Allotment of examination centre in a particular place will be at the discretion of the Board of Examination of the Institute which reserves the right to cancel any centre if there is insufficient number of students. IIBM courses are industry endorsed certificate courses, not degrees.. The Institute reserves the right to change the course details without notice as per the prevailing conditions GST of 18% is applicable on all the course. Issue 1/12/2017

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