INDIAN INSTITUTE OF FOREIGN TRADE

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(DEEMED UNIVERSITY)

B-21 QUTAB INSTITUTIONAL AREA, NEW DELHI-110016

Important Enclosures:

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A demand draft of ` 1,200/- (` 600/- for SC/ST/PH candidates) in case the Form is downloaded from the IIFT’s website www.iift.edu – in favour of Indian Institute of Foreign Trade payable at New Delhi.

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SC/ST/PH/OBC (non-creamy layer) candidates to attach necessary certificate.

APPLICATION FORM

EXECUTIVE MBA (2012 – 2013)

1. Name in full: ___________________________________________________________

(in Capital Letters) (First) (Middle) (Last)

2. Name in Hindi: _________________________________________________________

3. Father’s Name _________________________________________________________

4. Mailing Address with Pin Code:

_____________________________________________________________________

Tel. Nos.: (Res.) : ____________________________ (Off) : _______________________________________

Fax : ____________________________ Email : _____________________________________

Mobile : __________________________

5. Permanent Address with Pin Code:

_____________________________________________________________________

Tel. Nos.: (Res.) : ____________________________ (Off) ; _______________________________________

Fax : ____________________________ Email : ______________________________________

FOR OFFICE USE

D.D./IIFT Receipt No.: __________

Date: ______________________

Amount: ____________________

Bank: ______________________

PHOTO

Last Date for receipt of filled-in Application Form : Friday, 24 August 2012

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6. Category : General SC ST PH OBC

(non-creamy layer)

7. Do you expect your organization to reimburse your fee Yes No

8. Demand Draft Details

Demand Draft No. Amount (`) Date

Name & Address of the Bank : ______________________________________________________________

9. Date of Birth (dd/mm/yyyy) _______________________

10. (a) Programme attended at IIFT (Please Tick)

EMIB (2006-08) EPGDIB (2007-09) EPGDIB (2008-10)

EPGDIB (2009-11) EPGDIB (2010-12)

Total CGPA Scored_____________

(b) Academic Record

In chronological order, list colleges/universities attended.

Degree Regular/Part- University/Institution Duration % of marks Subjects Time/Distance From To obtained

Learning

11. Work Experience

Please list the work positions you have held, including different positions within the same organisation:

Position Name & Address of Organisation From To

12. Total Work Experience after Graduation (as on 31^stAugust 2012): _____ Years ____ Months 2 0 1 2

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13. Brief description of Job Profile (50-100 words)

____________________________________________________________________

14. Describe any major achievement from your professional experience. (50-100 words) ____________________________________________________________________

____________________________________________________________________

15. What do you think are your important strengths in the context of your application for admission to IIFT’s programme? (50 words)

____________________________________________________________________

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16. Any other information. Please give any other information (attach a separate sheet, if necessary) which you consider relevant for the Interview Board.

____________________________________________________________________

DECLARATION BY THE CANDIDATE

I hereby declare that all statements made in this application are true, complete and correct. In the event of any information being found false or incorrect or ineligibility being detected before or after the examination, action may be taken by the Institute as deemed fit, against me.

__________________

Date_____________ Signature

(Note: Application found incomplete in any respect is liable to be rejected.)