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ADMIS
SION
FORM
Plot No.5, Rao Tula Ram Marg, Vasant Vihar, New Delhi-110057Tel:
+91-11-47285000/48/41/11, , Fax: 011-26144279, Email:
[email protected] Website: www.fiib.edu.in
SL. No.
1
1. Full Name Mr. /Ms.
2. Date of Birth
3. Current Address
DD MM YY
City PIN Code
State
E-mail
Applicants Mobile
Entrance Exam Details
CAT ---------------------------
Score---------------------------------
MAT----------------------------Score---------------------------------
Other--------------------------
Score---------------------------------
Attach an attested copy of Scorecard
Affix your recent
Passport size
Photograph
www .FIIB.edu.in/ admissions
LMC EDUCATION
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www .FIIB.edu.in/ admissions
4. Permanent Address
City PIN Code
State
5. Fathers Name
Fathers Profession
Mothers Profession
Fathers/Mothers Mobile
Board/University College Name Specialization
Year ofPassing
Percentage/ Grade
10+2+3 Bachelor'sDegree* (Specify)
S.No.
Degree/Certificate
2.
3.
5.
10+2
Post Graduate**(Specify)
Any Other(Specify)
1. 10th
4.
* Select relevant one for Bachelor's Degree--B.A., B.Com. B.
Pharma, B.E., B.Tech., B.Sc** Select relevant one for post Graduate
Degree-- M.A., M.Sc., M.Com., M.E. etc.
Note:
a) OVERALL PERCENTAGE OF MARKS MUST INCLUDE ALL SUBJECTS.b) If
you are awarded a grade point please convert them into percentage
ofmarks and indicate.
c) If there is a formula given by University for conversion it
may please be stated.d) If you are a rank holder, indicate the same
with class awarded.e) * If yet to be completed, please give us the
details of your present status and percentage / grade scored
till
your last semester / year.
6. Mothers Name
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3
Name & Address ofOrganization Designation Nature of Work
Last SalaryDrawn(Rs./ Month)
Work Experience (if any):
Period
From To
TOTAL EXPERIENCE (IN YEARS)
Academic/ Professional Awards/ Medals/ Prizes/ Scholarship/
Certificate/ Honours, etc.
Year Name of Award Awarding InstitutionLevel (State /
National/International )
Remarks
Major Extra-Curricular Activities:
Year Activity Role Level Remarks
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4
Do you require hostel accommodation? Yes No
DETAILS OF DEMAND DRAFT: DD No._____________________________BANK
________________________________________________________DATE
__________________ Rs. ______________________
I ______________________________________ hereby certify that the
above informationsubmitted by me is correct and that I have not
provided any false or concealed any information.I understand that
my admission may be cancelled and amount paid by me forfeited,
incase anyof the above information given by me at the time of
admission is subsequently found to bewrong, concealed or false. I
agree to abide by the rules and regulations of the Institute.
____________________________
___________________________Signature of Parent/ Guardian Signature
of the Applicant
Date: _________________________Place:
__________________________
Enclosures:Attested photocopies of the documents ii, iii &
iv are required to be submitted along withthe application form.
Please specify below in checkbox (Do not attach original
documents):
I. Draft for Rs.1050/- favouring Fortune Institute of
International Business payable at NewDelhi, towards the
registration fees
ii. Date of Birth Certificate (Class X)iii.Graduation mark sheet
(latest year if final year is not available)iv.
MAT/CAT/XAT/ATMA/CMAT/GMATScorecard
(Incomplete and illegible applications are liable to be
rejected.)
Please state in about 100 words, why you wish to join FIIB's
PGDM Programme?
