8/3/2019 Mba -Stage-III Reg - Form

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The Institute of Chartered Financial Analysts of India University, TripuraUniversity Campus, Agartala-Simna Road, P O. Kamalghat Sadar 799210, Tripura(West)

Registration Form for the Stage-III of MBA Program

ToThe Admissions Officer,The Institute of Chartered Financial Analysts of India University, Tripura

Dear Sir,

I hereby register for the Stage III of MBA Program. The status of Groups cleared / Appeared in examinations is as under:

Groups Passed : A B C D E F

Groups Results awaited : A B C D E F

1. PERSONAL DETAILS (Use Capitals only)

Name Mr./Ms. : ___________________________________________________________________________________________(Use capitals) (As it appears in Official Records, Underline Surname)

Parents/Guardians Name Mr./Ms._____________________________________________________________________________

Mailing Address:_________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(City) (State) (Pin)

Tel.(Off.) ___________________________________Res.___________________________________Fax________________________________________(City Code) (Area code) -Number (City Code) (Area code) Number (City Code) (Area code) Number

Mobile Number_____________________________________E-mail_________________________________________________

2. FEE REMITTANCE: (The Fee Remittance Form is overleaf)

Please tick () the appropriate option:

Lumpsum Payment EMI Payment

Place: Date: Signature of the applicant:___________________

Enrollment Number

8/3/2019 Mba -Stage-III Reg - Form

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FEE REMITTANCE FORM

Enrollment Number: Name: Mr./Ms.

OPTIONI: LUMPSUM PAYMENT: Amount Rs.22,500 (without Training Classes) (By Bank Draft)

Remittance through Demand Draft (DD should be in favor of IUCF A/c IUT payable at Hyderabad.

DD Details : Name of Bank: DD No: Date: Amount Rs.22,50

OPTIONII: INITIAL PAYMENT : Rs.4,750 (By Bank Draft)

DD Details: Name of Bank: DD No: Date: Amount Rs.4,750

EMI FACILITY: The EMI amount: Rs.2,860 (without Training Classes)

(i) Postdated cheques7 of Rs. __________each (A/c payee postdated cheques in favor of IUCF A/c IUT should be enclosed). NOTE: On the baof each postdated cheque, the name of the applicant and the full address of the bank, branch with phone number should be mentioned in capiletters. Only MICR and multi-city cheques drawn on banks located in specified cities (as mentioned in the program prospectus) will be accepted.

To the ICFAI University, University Campus, Agartala - Simna Road, P.O. Kamalghat Sadar 799210, Tripura (West).I hereby confirm that I have signed the postdated cheques towards the payment of EMIs in relation to this Fee Remittance Form. I undertake notcountermand these cheques and also to honor all these cheques on due dates.

Sl.No.

Cheque NumberCheque Date

DD / MM / YYYYAmount

Rs.Sl.No.

Cheque NumberCheque Date

DD / MM / YYYYAmount

Rs.

1. 01 / 2860 5 01 / 2860

2. 01 / 2860 6. 01 / 2860

3. 01 / 2860 7. 01 / 2860

4 01 / 2860

Signature of the applicant:________________________

(ii) The postdated cheques enclosed are signed by (please tick ( )) Me Other person (in case of other person, please fill item no. (iii) given below):

(iii)Statement : [By the person (other than the applicant), who has signed the postdated cheques in connection with this fee Remittance Form as a Co-obligant].

To, the ICFAI University, University Campus, Agartala Simna Road, P O Kamalghat Sadar- 799210. Tripura (West).I hereby confirm that I have signed the postdated cheques towards the payment of Installments/EMI in relation to this Fee Remittance Form. I undertake not to countermthese cheques and also to honor all these cheques on due dates towards the EMI Facility. I am over 21. I understand and I am aware of my liability as co-obligant for EMof the applicant. I agree that I will settle the amount with the ICFAI University whether or not the applicant continues in the program. I understand the jurisdiction for disputes (if any) relating to the University is only / exclusively Agartala, Tripura. I hereby declare the information provided by me below is true and correct to the best of knowledge. My signature below certifies that I have read, understood and agree to the rules and regulations and my financial responsibilities. My details are as under:

Name: Mr/Ms.______________________________________________________________________________________________(Use capitals) (As it appears official records, Underline surname)

S/O / D/O_______________________________________________________________________________________________________________________Occuptation_______________________________________________________________________________________________

Mailing Address:____________________________________________________________________________________________(Use capitals) (House Number) (Street)

City _________________State___________________Pin number_____________E-mail_________________________________

Tel.(Off.) ___________________________________Res.___________________________________Fax___________________________________________(City Code) (Area code) -Number (City Code) (Area code) Number (City Code) (Area code) Number

Cell Number_____________________________________Date of Birth___________________________(Date Month Year)

__________________________________________________________

Place: Date: Signature of the person signing the cheques as a co-obligan

3.Declaration: I have carefully read the rules and regulations as given in this Document and Applications and agree to abide by the same. I understand that thrules are only indicative and may be modified /changed/revised. I will abide by the complete list of rules and regulations of the program as updated from time to I agree not to countermand and to honor all the postdated cheques enclosed by me towards the EMI facility. I understand that in case I withdraw from the progwill not be entitled to claim any refund of amount paid. I agree that I will settle the amount with the ICFAI University whether or not I continue in the prograunderstand that the Jurisdiction for al l disputes (if any) relating to the University is only/exclusively Agartala, Tripura. I hereby declare that the information provideme in the application is true and correct to the best of my knowledge. My signature below certifies that I have read, understood and agree to the rules regulations of the program, including Legal Aspects, and my financial Responsibilities.

_________________________Place: Date: Signature of the Applicant