APPLICATION FORM: -

Course Name P H D

Specialization H R

Counselor Name ANJALI City: BANGALORE________________

Applicant Details:

Name: J A Y A R A M A N

2 5 0 5 1 9 5 9
D.O.B. Male: X Female:

Married: X Unmarried: Nationality:

Father’s/ Husband’s Name: K U P P U S A M Y

Mother’s Name: M A N G A L A M

Correspondence Address:
1A - 36 S H A K T H I I S W A R Y A M A P A R T M ENT

A M B E T H K A R R O A D V E N K I T A P U R A M
C O I M B A T O R E T A M I L N A D U
Permanent Address:
A S A B O V E

0 9 9 4 4 0 0 0 0 9 0
Tel. No.: (M)

0 4 2 2 4 2 0 6 6 8 0
(R)

(O)

srividh@airtelmail.in
E-mail:

Academic Details:
Qualification Board/University Passing Year/Month Grade Specialization if any
BCOM MADRAS 1980 III COST ACCOUNTS

Work Experience:
Company name City/State Designation No. of Years Remarks
Krishna Flour Mills Bangalore Accounts Officer 7 years
K C Flour Mills Belgaum Accounts Manager 2 years
Sheba Polysacks Pvt Ltd Bangalore Accounts / Admn Manager 5 Years
Visvabharathi Textiles Ltd Tirupur Accounts Manager 4 years
Sujiths Consultancy Serviices Coimbatore Chief Executive Officer 10 years

Exam Option: From Home X Study Center E-mail:

Declaration by Applicant:
I declare that I have understood the norms of Indian Institute of Business Management and Studies. I
assure that I will abide by the conditions and standards of the institute. I am fully aware that if I am
found violating any conditions then my admission may be cancelled and I will be entirely responsible
for it.
Date:
Signature:

For Institute’s Use Only:

Fee Paid: Mode Of Payment:

Xerox Copy of Mark Sheets and Certificates in proof of all examination passed should be attached.
The Application form along with the Bank Draft should be sent to the Institute through Courier/ Speed Post.
For more than one application Xerox copy of this application proforma can be used.
Please Keep a Xerox copy of this application proforma for your record and reference.
Fee once paid is not refundable under any circumstances.

ADDRESS TO FORWARD DOCUMENTS & PAYMENT OF FEES PAYMENT:

INDIAN INSTITUTE OF BUSINESS MANAGEMENT & STUDIES. [IIBMS]

#291, IIBMS, 7th Main, MICO Layout, 2nd Stage-BTM Layout, Bangalore-560076.
Land Mark: 7th Main: - Behind, Between: BTM Water Tank & Reliance Fresh.
Tel: 09243434170 / 60 / 09246 83 74 18 / 09393 70 16 90.
APPLICATION FORM: -

Course Name

Specialization

Counselor Name City: ________________

Applicant Details:

Name:

D.O.B. Male: Female:

Married: Unmarried: Nationality:

Father’s/ Husband’s Name:

Mother’s Name:

Correspondence Address:
APPLICATION FORM: -

Course Name

Specialization

Counselor Name City: ________________

Applicant Details:

Name:

D.O.B. Male: Female:

Married: Unmarried: Nationality:

Father’s/ Husband’s Name:

Mother’s Name:

Correspondence Address: