Application Form Paste a recent color

photograph of size
3.5 x 4.5 cms.
For 2 year PG Program 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.: 1 2 1 8 -

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 Blood Group Mobile
D D / M M / Y Y Y Y

Email* Nationality

Mailing Address

City State Pin

Permanent Address

City State Pin

2. ACADEMIC RECORD
(a) School / Junior College
Class Name of the School / College Year of Passing % of Marks

XII 

(b) GRADUATION DETAILS

If Completed If Pursuing
Graduation Degree Title Medium of Duration
(in full form) Instruction (Years) Month & Year of % of Expected Month & % of
Passing Marks* Year of Completion Marks**

* Marks as calculated by the University; ** Percentage of marks till current semester/year.

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 Marks secured in the graduation
For eligibility criterion the percentage of marks secured in graduation will be as calculated by the University taking into account the following.
Please (3) appropriate box:
l Marks scored in all the years put together For any other criteria, please give details: ..................................... ...
...........................................................................................................
l Marks scored in the years excluding marks scored in the first year
...........................................................................................................
l Marks scored in final year only
...........................................................................................................
l 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 Semester-II Year-wise

Academic Year
Total Marks Marks Secured Total Marks Marks Secured 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:................................................................................................................................. City:.................................................

3. WORK EXPERIENCE [Please enclose the Experience Certificates from your Employer]

Company Name:

How many years of working experience do you have? Please tick (3)

Nil 1 - 2 years Above 2 years

4. How do you propose to fund your education? Please tick (3)

Parent’s Support Educational Loan from Banks Loans from Relatives / Others

5. Health
Self
Did/Do you suffer from any major illness/disability in the past/present? Please tick (3)
Yes No. If “yes”, please give details : _____________________________________________________________
___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

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6. Family Background
Father Mother

Name Name
Qualification Qualification
Occupation Business Professional Central Govt. Occupation Business Professional Central Govt.
State Govt. Public Sector Private Sector State Govt. Public Sector Private Sector
Others (please specify)________________________. Others (please specify)________________________.
Designation Designation
Salary/Income Salary/Income
Organization Organization
& Address & Address

City: City:
Mobile: Mobile:
Personal E-mail: Personal E-mail:

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

IBS Ahmedabad IBS Gurgaon IBS Kolkata

IBS Bengaluru IBS Hyderabad IBS Mumbai

IBS Dehradun IBS Jaipur IBS Pune

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 ibsat@ibsindia.org.
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 2019 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, 2019 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, 2019 will be refunded the admission fee by June 30, 2019 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

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 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 institute’s 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 Hyderabad, is a constituent of the ICFAI Foundation for Higher Education (IFHE), is a Deemed-to-be-University under Section 3 of the UGC
Act, 1956. The programs offered at IBS Hyderabad are: Two year full time MBA program and PhD program.
IBS Dehradun is a constituent of the ICFAI University, Dehradun.The 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, Gurgaon, Kolkata, Mumbai and Pune are the constituents of The Icfaian Foundation and IBS Bengaluru is a constituent
of The ICFAI Society. These campuses offer two year full time Post Graduate Program in Management. The Icfaian Foundation and The ICFAI
Society do not award any degrees / diplomas within the purview of prevailing regulations of AICTE / UGC.
IBSAT 2018 bulletin is issued by IBS Admissions Office on behalf of IFHE (Deemed- to -be -University); The ICFAI University, Dehradun; The ICFAI
University, Jaipur; The Icfaian Foundation and The ICFAI Society.

8. Declaration
I certify that the information presented in this Application Form is accurate, complete and honest to the best of my knowledge. I certify that I am aware
of the eligibility criterion for the program is 50% in graduation 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 certify that I have never been expelled from any college, not convicted by any court and no proceedings are pending against me.
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.

Place:...........................................

Date :............................................
Applicant’s Signature

© IBS, January 2019. All rights reserved. 4