Application Form

For 2 year PG Program

Paste a recent color

photograph of size
3.5 x 4.5 cms.
Photograph must not be
larger than this box.
Do not sign on the
Photograph
and do not staple.
You will not be allowed
to attend the Selection
Process without the
photograph.

Application No.:
Name of Candidate: Mr./ Ms.

(As it appears in the School/College/University certificates. Underline Surname)

1.

PERSONAL DETAILS (Use Capitals Only)

Date of Birth
D

Blood Group
Y

Mobile

Email*

Nationality

Parents Name Mr./Ms.

Tel (Res)

(Mobile)
(STD Code)

Parents Email:

Tel. No.

Mailing Address

City

State

Pin

State

Pin

Permanent Address

City

2.

ACADEMIC RECORD

(a)

SCHOOL / JUNIOR COLLEGE

Class

Name of the School

Year of Passing % of Marks

XII

(b)

GRADUATION DETAILS

Graduation Degree Title

(in full form)

Medium of
Instruction

Duration
(Years)

If Completed
If Pursuing
Month & Year of % of
Expected Month & Year of
Passing
Marks* Completion of Final Examination

* Marks as calculated by the University.

MARKS SECURED IN THE GRADUATION

For eligibility criterion the percentage of marks scored in graduation will be as calculated by the University taking into account the following.
Please () appropriate box:
For any other criteria, please give details: .....................................
Marks scored in all the years put together
......................................................................................................................
Marks scored in the years excluding marks scored in the last year
......................................................................................................................
Any other criteria
......................................................................................................................
Attach the required page giving the details.
......................................................................................................................

Please fill Year / Semester details as applicable. In case results are awaited indicate as RA.

Semester-I
Academic Year

Total Marks

Marks Secured

Semester-II
Total Marks

Marks Secured

Year-wise
Total Marks

Marks Secured

1st Year
2nd Year
3rd Year
4th Year
The students pursuing graduation have to indicate marks upto current semester / year.
(c)

Have you taken coaching for any B-School admission tests?

Yes

No.

If yes, please provide details :

Coaching Center Name: .......................................................................................................................................

3.

City: ..................................................

WORK EXPERIENCE [Please enclose the Experience Certificates from your Employer]
Company Name:
How many years of working experience do you have? Please tick ()
1 - 2 years

4.

How do you propose to fund your education?

Parents Support

5.

Above 2 years

Educational Loan from Banks

Please tick ()
Loans from Relatives / Others

HEALTH
Self
Did/Do you suffer from any major illness/disability in the past/present? Please tick ()
Yes

No. If yes, please give details : _____________________________________________________________

____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________

6.

FAMILY BACKGROUND
Father

Mother

Name

Name

Qualification

Qualification

Occupation

Business

Professional

Central Govt.

State Govt.

Public Sector

Private Sector

Occupation

Others (please specify)________________________.

7.

Business

Professional

Central Govt.

State Govt.

Public Sector

Private Sector

Others (please specify)________________________.

Designation

Designation

Salary/Income

Salary/Income

Organization

Organization

& Address

& Address
City:

City:

Mobile:

Mobile:

Personal E-mail:

Personal E-mail:

CAMPUS PREFERENCES (Please indicate preferences for all campuses 1 for first preference,
2 for second preference and so on.)

IBS Ahmedabad

IBS Gurgaon

IBS Mumbai

IBS Bengaluru

IBS Jaipur

IBS Pune

IBS Dehradun

IBS Kolkata

Disclosure, Legal Aspects and Regulations

All the applicants to the IBS Programs are advised to read the Disclosure, Legal Aspects and Regulations given below carefully and understand the
contents clearly. If they need any clarifications, they should contact the Admissions Office at [email protected].
Provisional Admission: All admissions are treated as provisional until they are duly confirmed. The admission of candidates who are admitted to IBS
campuses and who are in the final year of graduation will be treated as provisional only, subject to their completion of graduation requirements by
May 2015 with 50% aggregate marks (or above) as per the rules followed by their respective university. The last date for submission of the proof of
graduation is November 01, 2015 failing which the provisional admission may be cancelled.
Withdrawal and Refund of Fee:
Admission fee:
The students who withdraw from the program on or before 5.00 pm on May 15, 2015 will be refunded the admission fee by June 30, 2015 after deducting
the administrative charges as per UGC guidelines.
1st installment of Fee:
Fee Paid is not refundable.
In the case where a provisional admission of a student is cancelled due to not scoring 50% marks in graduation, 75% of the 1st installment shall be
refunded after adjusting dues if any.
Details of the Programs may be modified from time to time for academic, legal, regulatory and operational reasons. The students will be governed by the
latest regulations applicable to them during the relevant academic year. Neither IBS nor any third party assumes any liability of any kind to any person
for providing this information, whether or not such persons rely on it and even if they inform the IBS of their reliance on it.
The documents may contain forward-looking statements like, but not limited to, general market, macro-economic, governmental and regulatory trends,
technological developments, court decisions, legislative developments, award of degrees/diplomas, scope for further studies, career opportunities for

students from the IBS. Such forward-looking statements contained herein are subject to certain risks and uncertainties that could cause actual results to
differ materially from those reflected in the forward-looking statements. IBS undertakes no duty to update any forward looking statements, to reflect future
events or circumstances.
Enrollment Agreement: The Application Form constitutes the Enrollment Agreement (hereinafter referred to as the Agreement) between the candidate
and the IBS. Entire Agreement: This Agreement constitutes and expresses the entire agreement and understanding between IBS and the students of
IBS in reference to all matters herein referred to, all previous discussions, promises, representations, and understandings relative thereto, if any, had
between the parties hereto, being herein merged. No Third Party Beneficiaries: Enrollment of any candidate, shall not entitle any person (including,
without limitation, members) to any rights as third party beneficiary. No Obligation to Services, etc.: IBS has no obligation to render any services to
the students beyond two years (being the period of study) after the date of enrollment. To clarify further, no obligation Disclosure, Legal Aspects and
Regulations of IBS shall survive beyond two years after the date of enrollment. Limitation of Liability: The liability of IBS towards the students is
limited only to the extent of the fee paid by them to IBS. To clarify further, IBS shall not be liable to the students for punitive, exemplary, special, indirect,
or consequential damages, including, without limitation, lost profits. IBS shall also not be liable to fee paid to other organizations. Assignment: The
students of IBS cannot assign this Agreement or any part thereof. IBS may, without necessity of the students consent assign its rights and obligations
under this Agreement to a successor organization. Force Majeure: IBS shall not be liable for delay or failure in performance of any of its obligations under
the Agreement when such delay or failure arises from events or circumstances beyond the reasonable control of IBS (including, without limitation, acts
of God, fire, flood, war, explosion, sabotage, terrorism, embargo, civil commotion, acts or omissions of any government entity, supplier delays,
communications or power failure, equipment or software malfunction, or labor disputes). Indemnity: A student of IBS agrees to indemnify, defend and
hold IBS harmless from and against any and all loss, damage, liability and expense (including reasonable attorneys fees and costs) arising out of any
third party claim, action or proceeding based directly or indirectly on the acts of omission or commission by the member or his/her agents, the breach
or alleged breach or failure to comply with any applicable laws or regulations, concerning the practice of profession of management. Arbitration: All
disputes relating to or arising out of this Agreement pertaining to IBS campuses shall be settled by reference to arbitration only and not by recourse to the
courts of law, as per the applicable Indian Law including the Arbitration and Conciliation Act of 1996. Arbitration shall be conducted by an arbitration tribunal
consisting of a single member only. The institutes nominee shall be the persona designata as an arbitrator. The venue of arbitration shall be Hyderabad,
India. The arbitration clause shall however not apply if IBS and/or the authorized agent decides to prosecute any student for any criminal offences,
including but not limited to dishonor of postdated cheques. Applicable Law: With respect to IBS campuses the Agreement shall be deemed to have been
made in Hyderabad in the State of Telangana and accordingly the same shall be governed by the laws of the State of Telangana, India. The courts of
Hyderabad shall alone have the exclusive jurisdiction to entertain any dispute/judicial proceeding arising out of or in relation to this agreement.

Legal Status
IBS Dehradun is a constituent of the ICFAI University, Dehradun. ICFAI University, Dehradun is established through an Act of the State Legislature of
Uttarakhand and is recognized by UGC under Section 2(f) of the UGC Act. IBS Dehradun offers the MBA program.
IBS Jaipur is a constituent of the ICFAI University, Jaipur. The ICFAI University, Jaipur has been notified by the Government of Rajasthan (Act No. 20
of 2011). IBS Jaipur offers the MBA program.
IBS campuses at Ahmedabad, Bangalore, Gurgaon, Kolkata, Mumbai and Pune are the constituents of Icfaian Foundation (IF). These campuses offer
two year full time Post Graduate Program in Management. IF does not by itself award any degrees/ diplomas and the program does not fall within the
purview of current regulations of AICTE, as such no approval is sought from it.
IBS PGPM/MBA bulletin is issued by IBS Admission Office on behalf of ICFAI University, Dehradun; ICFAI University, Jaipur; and Icfaian Foundation.

8.

DECLARATION
I certify that the information presented in this Application Form is accurate, complete and honest to the best of my knowledge. My signature below certifies
that I am aware of the eligibility criterion for the program and fee refund policy in the event of failure to fulfill the eligibility criteria. I understand and agree
that any inaccurate information, misleading information or omission will be a cause for the withdrawal of any offer of admission or for
disciplinary action, dismissal or revocation of diploma, certificate, or degree if discovered at a later date.
I understand that all admissions are based strictly on merit and declare that I will not violate the rules against canvassing directly or indirectly to seek
admission and/or to seek any undue/special favors outside the framework of rules in force from time to time. I hereby understand and accept that the
decision of admission by the Admissions Committee is final and binding on me.
I have carefully read the academic and administrative rules and regulations of the PG programs as given in the brochure and pages 3 and 4 of this
application form and agree to abide by the same. I also understand that IBS reserves the right to change/modify the rules and regulations from time to time.

Applicants Signature : .......................................................................

Place:...........................................
Name : Mr./Ms. ...............................................................................
Date :............................................

IBS, January 2015. All rights reserved.