[Established by Shree Satya Sai Education Trust (Regd. 740/2016 Govt.

of India)]
MIBM-GLOBAL Matrix Institute of Business Management, C 171, Sector-63, Noida-201301
Admin Office: 0120-4571323, Marketing Office +91-96909-00054

APPLICATION FORM FOR ADMISSION

(PLEASE FILL THE COMPLETE FORM IN BLOCK LETTERS) Affix Self-
attest recent
photograph
1. Programme applied for ……………………………………………………………… of candidate,
Also attach 3
2. Give Electives if any: ……………………………………………………………........ photographs
for Office
3. Complete Name: ………………………………………………………………….......

4. Candidate’s Contact Number: …………………………………………….......….....

5. Father's Name: ………………………………………………………………….........

6. Father’s Number: ………………………………………………………………….....

7. Mothers Name: ………………………………………………………………….........

8. Mother’s Number / Alternate Emergency Number ………………………………..

9. Gender: Male [ ] Female [ ]

10. Date of Birth: Day [ ][ ] Month [ ] [ ] Year [ ] [ ][ ][ ]

11. Nationality: ............................... NRI [ ] Foreign Student [ ]

12. Correspondence Address: (In capital letters)

(Please mention the address where you would like to receive your Study Material)

..............................................................................................................................................
City: ........................................... District: ............................ State: ....................................
E-mail address (if any): ...................................................................................................... .

Pin Code: ………………………… Telephone: ………………………….................

Cell Phone Number: ............................ Preferred Contact No: .......................................

13. Permanent Home Address: (In capital letters)

..............................................................................................................................................
City: .......................... District: ............................ State: ......................................................
E-mail address (if any): .......................................................................................................

Pin Code: ………………………… Telephone: …………………………..

 [Established by Shree Satya Sai Education Trust (Regd. 740/2016 Govt. of India)]
MIBM-GLOBAL Matrix Institute of Business Management, C 171, Sector-63, Noida-201301
Admin Office: 0120-4571323, Marketing Office +91-96909-00054

14. Educational Data:

S.No. Examination Passed Year of Passing Board/Institute/University % of Marks
1.
2.
3.
4.
5.

15. Course Selected: (Please refer to the Information Brochure or ask your Counselor)

Programme Select
DBA Programme
DBA+ MBA 1 year Programme
DBA+ MBA 2 year Programme
MBA 1 year Programme
MBA 2 year Programme
Executive MBA Programme
Duel Certification Programme

Fast Track Programme Select

Fast Track DBA Programme
Fast Track DBA+ MBA 1 year Programme
Fast Track DBA+ MBA 2 year Programme
Fast Track MBA 1 year Programme
Fast Track MBA 2 year Programme
Fast Track Executive MBA Programme

16.
a) Have you opted for fast track system to complete the programme? Yes [ ] No [ ]
b) If yes, have you enclosed fee for Fast Track System? Yes [ ] No [ ]

17. Payment Details:

Cash: [] Draft: [] NEFT/Net Transfer: []
 [Established by Shree Satya Sai Education Trust (Regd. 740/2016 Govt. of India)]
MIBM-GLOBAL Matrix Institute of Business Management, C 171, Sector-63, Noida-201301
Admin Office: 0120-4571323, Marketing Office +91-96909-00054

18. Mode of Payment of fee:

Lump sum: [ ]Installment: [ ]

Name of
Bank DD /Cheque / EFT No Date of Issue Amount

*** Service Tax of 15% is applicable on all the course of MIBM-GLOBAL.

19. Self Attested photo copy of following Documents Attached herewith (Please Tick):
Education Mark sheet/ Diploma [ ] 3 Photographs [ ] Experience Certificate [ ] CV [ ]

Instructions

Complete application form should be sent to, by Registered Post/Courier/Speed Post.

Complete application form should be accompanied with the required fee (crossed Demand Draft/Cheque drawn in
favour of MIBM-Global payable at Noida or Counter foil of Electronic Fund Transfer Receipt).

Declaration

I hereby declare that if I am enrolled in the programme applied for, and I agree to pay balance of fee installments on the agreed specified dates. I
further declare that the information provided by me in the application is true and correct to all best of my knowledge and belief. A list of
documents pertaining to my programme is attached along with the application form. I have carefully read the rules and regulations as given in this
Application and agree to abide by the same. I understand these rules are only indicative and MIBM has the right to modify/change/revise it from
time to time. I agree not to countermand and to honor all the post dated cheques enclosed by me towards the Installment Facility. I also agree and
understand that in case I withdraw from the program, I will not be entitled to claim any refund of amount paid. I agree that I will settle the amount
with MIBM-GLOBAL whether or not I continue in the program. All the disputes and opinion differences that arrive out of this program, during
the term of the programme or after completion shall be referred to the sole Arbitration which will be nominated by MIBM, whose decision shall
be final on every matter arising hereunder. It is expressly agreed that the student shall not raise any objection. The sole Arbitrator is nominated by
the MIBM. The venue of the arbitration shall be at Noida and the provisions of the Arbitration and Conciliation Act 1996 shall apply. My
signature below certifies that I have read understood and agree to the rules and regulations, including “Legal Aspects” and my financial
responsibilities.

Date.................. Place......................... Signature of Student

Rules and Regulation of the Institute

1. The Management of MIBM reserves the right to accept or reject an application without assigning any reason whatsoever.
2. The necessary fee to be paid by DD would be drawn in favor of “SHREE SATYA SAI EDUCATION TRUST” Payable at
Noida will have to be sent along with the filled up application form.
3. The Management of MIBM-GLOBAL reserves the right to change the course details without notice as per the prevailing
conditions.
4. MIBM-GLOBAL courses are industry endorsed certificate courses.
5. Service Tax of 15% is applicable on all the course of MIBM-GLOBAL.