Institute of Business Administration AMDISA Secretariat

University of Dhaka Hyderabad, India Please clip two

copies of your
recent passport-
size photograph

Advanced Certificate in Business Administration

Application for Admission

Fill applicants name in BLOCK letters. If currently unemployed, provide only one contact address.

1. Name

2. Date of Birth:

dd mm yyyy

3. Nationality:

4. Gender: Male Female

5. Address 1
(Home)

6. Address 2
(Work)

7. Telephone #

Cell Phone Landline

8. E-mail:

9. Source of Financing: Self Organization

10. Give details of your employment (maximum three), starting from the current/most recent:
Organization Designation Duration (From-To)

11. Total year(s) of full-time employment:

12. Please list academic degrees earned, starting from the most recent:

Degree Institution Year Awarded Area / Major Class / CGPA

13. Have you ever been enrolled in any degree/course at this institute i.e. IBA? Yes No
If yes, please specify:
Degree/Course Year Attended

Declaration
I have read the program brochure and I agree to abide by the requirements of the
program. The information provided in this application form is true and correct.

Signature of the Applicant Date

The application form can be downloaded at www.iba-du.edu