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Application Form for SIIBMBA (International Business, Agri
Business & Energy & Environment) (2011 2013)
__________________________________________________________________________________________
To,The Director,Symbiosis Institute of International Business
[SIIB],Pune
Madam,
I, the undersigned have applied for the following programme/s of
SIIB (2011 2013 Batch)
MBA International Business MBA Agri Business MBA Energy &
Environment
*********************************************************************************************************************************Personal
Details : -
1) Name:First NameMiddle NameSurname
2) Category: General SC ST Differently Abled Migrants from
J&K
3) Gender: Male Female 4) Place of Birth:
5) Date of Birth: 6) Blood Group:
(Date) (Month) (Year)
7) Nationality:
8) Passport No.:
9) Permanent Address: -
City : State :
Pin Code :
(Please mention the same address as given during the SIIB online
registration. This address will be used for all
future (postal) correspondence)1
SYMBIOSIS INSTITUTE OF INTERNATIONAL BUSINESS (SIIB)is a
constituent of SYMBIOSIS INTERNATIONAL UNIVERSITY (SIU)
(Estd. Under section 3 of the UGC act 1956, notification no.
F-9-12/2001-U-3 of the Govt of India)Accredited by NAAC with A
grade
SNAP ID: GD/PI No.:
Affix yourphotograph
here
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10) Residence Phone No.:(with STD code)
11) Mobile No.:
12) E-Mail ID:
(Please mention the same e-mail ID with which you registered for
SIIB online registration.
This e-mail ID will be used for all future e-correspondence from
the Institute)
*********************************************************************************************************************************Educational
Details : -
Year ofPassing
School / College / University Stream Degree If
completed(Aggregate %
of marksof all years)
If appearing forFinal year
(Aggregate % ofmarks ofall years
appeared)
Xth
__ __ __
XIIth__ __ __
Graduation
PostGraduation
Work Experience Details : -
Name of Organization Sector No. ofYears
DurationFrom To
[Full time Work Experience of more than one year only will be
considered]
Parents Details : -
Relation Name Contact Details Occupation Organization
Father
(M):
E-mail:
Mother
(M):
E-mail:
LocalGuardian
(M):
E-mail:
Address:
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Achievements (Academic / Extra Curricular)
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Describe yourself briefly, also mention special skills (if any)
like proficiency in vocal classical music,classical dance,
instrumental music, rock climbing, writing poetry, etc.
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I hereby undertake the following: -
1) I hereby submit to the disciplinary jurisdiction of the
Vice-Chancellor, and other Officers and authorities ofthe Symbiosis
International University (Estd. under section 3 of the UGC Act 1956
vide notification no. F-9-12/2001-U3 of the Govt. of India) /
Institute / Symbiosis Society and shall observe and abide by the
rulesmade by the Vice-Chancellor and by the Head of the
Institute.
2) I have carefully noted the rules and the process of admission
to SIIB and rules pertaining to refund offees, as given in the
Prospectus which I am required to follow and shall in matter of
interpretation acceptthe decision given by the Chancellor / Vice
Chancellor of SIU and the Director, SIIB as final and binding.
3) I shall take note of all communications sent to me by post /
courier / e-mail and follow the same from timeto time.
4) I understand the Institute may vary or reverse any decision
made on the basis of incorrect or incompleteinformation submitted
by me.
5) I agree to inform the Institute immediately if there is any
change in the information I have submitted.6) I understand that,
SIU / SIIB may obtain official records from any educational
institutions I have previously
attended.7) I understand SIIB will not be responsible for delays
of any kind due to reasons beyond its control.8) I understand that
if admitted, my admission will be provisional and subject to
fulfillment of the following
criteria by me: - Submission of my Migration Certificate,
Statement of Marks, Category Certificate (if applicable),
Degree Certificate (of qualifying exam) from my College /
Educational Institution from where I havecleared my qualifying
Examination and subsequent acceptance of my eligibility form by
SymbiosisInternational University [SIU]
9) I declare that, all the information I have given is true and
correct.10) I accept that, all the disputes will be subject to Pune
Jurisdiction only.
Date: ______________________________
Place: ______________________________
Name & Applicants Signature:
________________________________________________________________
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