INSTITUTE OF BUSINESS MANAGEMENT & TECHNOLOGY

#298, 100ft. Ring Road, 4th Phase, 7th Block, Banashankari 3rd Stage,
Bangalore - 560 085. Tel : +91-80-26791740, 26798528 Telefax: +91-80-26790517
Email-mail: ibmtedu@vsnl.com Website: www.ibmtedu.org

APPLICATION FORM

Form No.

Write in CAPITAL LETTERS as per your Marks Card

Name :

Please affix
passport photo
(not older than
six months)

Father's Name :

Mothers Name :

D D

Date of Birth :
Gender :

M M

Y Y Y Y

Where do you want to receive your Letters?

Tick any ONE

PA
PA = Permanent Address

Or

AC
AC = Address for communication

Permanent Address :

IMPORTANT
Please read instruction carefully before
filling the application form. Check and
attach all relevant items. Incomplete
Application will not be considered.

Town :
District :

Attach your Call Letter

State :

Application fee through a bank Draft

for Rs. 1000/- is drawn in favor of the

Pin code :
Address For Communication:

MAT/ATMA/CAT/XT score card

Town :

Those who are appearing for their

District :
State :
Pin code :

Photocopy of Class X & XII / PUC

E-mail :
Country Code

Area Code

Telephone Number

One stamp size photograph (not Older

than six months) Letter of sponsorship

Telephone :
STD Code

Telephone Number

Resident:

One Self-addressed envelope with

postage stamps of Rs. 50 only. (Please

Mobile:
Fax:
Details of Application Fee:
Demand Draft No.

Date:

M M

Bank _______________________________________________ Branch _____________________________________________________

For Office Use Only:

1. Test appeared for (Attach Score Card) :

MAT

ATMA

Date of Test:

CAT

XAT

Score : .

2. Educational Background:
Course

Subject

School/College/University

Year of
completion

Grade / %

XII/PUC

Graduate Degree

P.G. Degree

3. Additional Qualification if any

Subject

Institution

Year of
Completion

Grade / %

4. Work Experience if any:

Organization

Designation

5. Computer Proficiency:

6. Extra Circular Activities

7. Awards and Prices

8. Hobbies

Duration

9. Write a short note on your career aspiration and why do you wish to study this course (Not more than 250 words)
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10. Why do you wish to study at the Institute of Business Management and Technology B'lore?
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Do you want to avail residential accommodation:

Yes

No

(If yes, please fill up the Accommodation application form and attach.)

I hereby declare that the information provided in this form is true to the best of my knowledge and belief.
If any information is found to be untrue at any point of time the admission is liable to be cancelled.
I have read the prospectus and understood the contents. I understand that the payment of the fee is
subject to rules & regulations of the Institute, I understand that the fee is payable for all courses as per
schedule. Fee once paid is non refundable. I undertake to abide by the rules of admission to the Institut e.

Date :
Place :

Specimen Signature of the Applicant