The Institute of Islamic Banking and Finance

# 12-2-800/445, Dilshad Nagar, Mehdipatnam, Hyderabad - 500 028. A.P. INDIA. Tel. 91-40-23522847 E-mail : info@islamicbankinst.com Website : www.islamicbankinst.com Registration Form for

POST GRADUATE DIPLOMA IN ISLAMIC BANKING & FINANCE

1. 2. 3. Name of the candidate Mr./Ms./Mrs. : Date of Birth : Educational Qualification (Start with the latest with year of passing and Class / Division secured Board / University) : a) b) c) d) 5. 6. Employer details, if employed : Address for communication - Mailing Street : State : Country : Tel. No. : Mobile : Fax : E-mail : 7. Option (Select any one) : B-Learning (Course material in printed books form) E-Learning (Course material on CD only) City : Pin Code :
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Declaration :
I hereby declare that the information furnished above is true to the best of my knowledge and belief. I hereby agree to abide by all the rules and regulations of the Institute of Islamic Banking and Finance in force and likely to be amended, modified in future. Signature of the Candidate Enclosed here with a Demand Draft No.......................................... dated ...................................... drawn on .........................................................Bank...........................................Branch for Rs. .................... (Rupees ....................................................................................................) towards full payment of Course fee.

Students from outside INDIA please fill in the particulars of mode of remittance DD/TT/SWIFT, amount in Indian Rupees/US$/any other as per details given in the prospectus for respective countries as applicable. Registration fees must be paid by DD only. Out station cheques not acceptable for this. Please write your name in pencil on the reverse of the Demand Draft and enclose TWO (2) PASSPORT SIZE PHOTOGRAPHS in color for the purpose of issue of identity card. This is a pro-forma application and if the space provided is found insufficient an additional sheet of A4 size paper can be attached giving details.