THE INSTITUTE OF FINANCE MANAGEMENT

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Application for Admission to Undergraduate Courses Offered by the Institute of Finance Management for academic year 2011/12

BASIC CERTIFICATE FORM
FOR OFFICIAL USE ONLY Date of receipt Application fee receipt No Amount Admission number Signature TO BE COMPLETED BY APPLICANT Course Choices Choice (1)_____________________________________________________(in Capital letters) Choice (2)______________________________________________________ Mode of study (if applicable to your choice) Full Time ( appropriate Note: This form must be returned to the Rector, IFM, P. O. Box 3918, DSM before 30th June 2011. APPLICANTS PERSONAL PARTICULARS 1. Last name (Capital letters)_____________________________________________________ First name ____________________________________ Initials________________________ Note: The names entered on this form must be the same as those on your CSE, ACSE or Equivalent document. 2. Sex _____________________________ (3) Date of Birth ___________________________ 4. Place of birth______________________ (5) Religion _______________________________ 6. Marital Status _____________________ (7) Citizenship ____________________________ 1 ), Part Time( ) .Tick (√ ) as

Basic Certificate in Insurance and Social Protection (BCISP) . Basic Certificate in Accountancy (BCA) – 1 year full-time part time B Department of Banking 1. Basic Certificate in Tax Management (BCTM) -1 year full time part 2 . Basic Certificate in Banking and Finance (BCBF) – 1 year full time part time II C FACULTY OF COMPUTING. BANKING AND FINANCE Department of Professional Accountancy 1.8. Permanent Address _________________________________________________________ E-mail address __________________________________________________ Telephone number_______________________________________________ 9. Course open for application (Please tick) I A FACULTY OF ACCOUNTING. Basic Certificate in Computer Studies (BCS) .1 year full time part time III D FACULTY OF INSURANCE AND SOCIAL PROTECTION Department of Insurance and Social Security Administration 1.1 year full-time part time IV E FACULTY OF ECONOMICS AND MANAGEMENT SCIENCES Department of Tax Management 1. INFORMATION SYSTEMS AND MATHEMATICS Department of Computer Science 1. Name and address of person to be notified in case of emergency Name______________________________________________________________ Relationship ________________________________________________________ Address _____________________________________________________________ Telephone___________________________________ email____________________ 10.

(a) Certificate of Secondary Education Examination (CSEE)/ National Form 4 or Equivalent Subject Grad e Year Index No. Subject Grad e Year Index No._______________________ Examination Centre_______________________ Country ________________________________ 3 . Subject Grad e Year Index No.11. Examination Authority____________________________ Division___________________ Index No._______________________ Examination Centre_______________________ Country ________________________________ (b) Advanced Certificate of Secondary Education Examination (ACSEE)/ Form 6 or Equivalent Subject Grad e Year Index No. Examination Authority____________________________ Division___________________ Index No.

Classific ation Award Note: Copies of CSE and ACSE level must be attached 13.12. certificate. university/ institute/ college Degree. Give details of any qualification other than ACSEE. etc Institutio n/Colleg e Course Year Enrolled Year Graduat ed Reg No. Sponsorship Information: If you will be sponsored by an organization please let the organizations nominating official fill and stamp in the space below: Name of Organization Address Telephone number(s) Name of Nominating Official Title Official Stamp 4 . Applicants service particulars: Employer Post Held Date(s) 14.g. Diploma. form six or its equivalent e.

ACCOUNT NUMBER 01J1042984102. TOWER BRANCH. Block A. You are advised submit the pay-in-slip to room 320 (3rd floor). The deadline for receiving applications will be 30th June 2011. I am aware that the Institute deserves the right to reject any application and withdraw any offer of admission should all or part of the above information be found to be false and or incorrect. where you will be issued IFM receipt of payment. Note: You can pay at any CRDB Branch in Tanzania. The Application fee is Tsh 40.000. IFM. Your form will not be processed without the payment of the application fee.00 5 . You need to attach the paying –in-slip with your form. Applicant Declaration I declare that all the above information is true and correct to the best of my knowledge and belief. FULL NAME OF APPLICANT _______________________________ DATE:_______________________SIGNATURE:________________ YOU CAN PAY THE APLICATION FEES TO: THE INSTITUTE OF FINANCE MANAGEMENT BANK: CRDB. or if any offer was erroneously made.If private sponsored give name and address of the person who has agreed to support you____________________________________________________________ 15.