QUALIFICATION DECLARATION

BY

“MR. / MS.______________________________________________________”

TO

“INDIAN INSTITUTE OF BUSINESSMANAGEMENT & STUDIES-[IIBMS]”

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This declaration is made and executed on the day of 02nd Dec. 2008. AT BANGALORE,

I “MR._____________________” Age _____Yrs, an Indian citizen; hereafter

called as “Declarant” OR “Applicant” which expression shall mean and include
it’s legal heirs, representatives, administrators, executives & assigns etc…of part
one.
AND

“INDIAN INSTITUTE OF BUSINESS MANAGEMENT & STUDIES-[IIBMS]” - an

Institution, (Herein after called the “INSTITUTE” which expression, where the context
so permits, shall mean and include her legal heirs, representatives, administrators,
executors & assigns) of the part two;

Whereas the “APPLICANT” has requested to the “INSTITUTE” to allow enrolling

him/her self for management studies from IIBMS & “INSTITUTE” has agreed to do
so on the terms and conditions herein contained.

NOW THESE PRESENT WITNESSES AND IT IS AGREED AND DECLARED

BY BOTH THE PARTIES AS FOLLOWS.

1) This is declared by the “APPLICANT” that he had successfully completed the

course of “_______________________________________________________”
in the year of ___________________. Also, that he has lost his documents of
mark sheet / certificate of passing / convocation of
___________________________________________ in the month/year of
__________ (As-per Annexure-A.);

2) DEFAULT:
In case the declaration by “Applicant” proved to be false anytime in future

 The “INSTITUTE” reserves the right to Black List the “Applicant”

 ”APPLICANT” him/her self will be liable for any penalty or charges
which may be applicable to the “Applicant” from any third party.

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  The “INSTITUTE” will not be responsible for kind of loss to the
“Applicant”.
 “INSTITUTE” will not be responsible of any kind of loss.

FOR IIBMS, BANGALORE SIGNATURE OF LOAN APPLICANTS

MR. VIGNESH ACHARYA MR. / MS. ____________________

INSTITUTE APPLICANT

WITNESS:

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Annexure: A

To,
ADMISSION REGISTRATION DEPARTMENT,
INDIAN INSTITUTE OF BUSINESS MANAGEMENT & STUDIES

Sir / Madam:

“I Mr. / Ms.______________________________________________________________,

Hear-by declare that, “I have successful completed studies of:

_______________________________________________________________________
_______________________________________________________________________

I have lost my all/few Mark-sheets, Passing Certificates & Convocation Certificates. Also
I do not have any Xerox copy of the same. I am interested to peruse Management courses
form your institute – IIBMS. As per eligibility criteria I am eligible to apply for the
course of ________________. I request you to allow me to enroll myself as a student of
your institution with this declaration. I am also aware of all the terms of enrolment to
IIBMS & I agree to abide by the same.”

Yours Truly,

Applicant
MR.______________________

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