Student Referral Form

Date:

To be filled by the IIHS student:

1. Name :

2. Registration Number at IIHS :

3. Name should be mentioned in your cheque :

Prospective Student Details:

4. Name of the Prospective student :

5. Course Required at IIHS / Registration No :

6. Contact Details of the Prospective student;

Tel: Mob:
E-mail:

7. How do you know the above student :

Official Use Only

Referral Acknowledgement Number:

Commission to be paid :

Due Date:

Reference Number:

Note:

 When the new student makes an upfront or a semester payment the stipulated
commission will be paid upon registration.
 If the new student opts for a monthly payment plan, the stipulated commission will
be paid after the new student pays 3 months tuition fees to IIHS.
 Prospective student you introduce should have had no previous contact with IIHS.
(This can be traced through the IIHS inquiry system)