Business School     
INDIAN INSTITUTE OF COMMERCE AND TRADE, LUCKNOW
Department of Distance and Open Learning
APPLICATION FORM FOR ADMISSION
(Please fill clearly in block letters and mark  tick in appropriate box)
 
Personal Detail:
1. a) Programme Applied For:
2. Programme Code :
3. Name:
4. Father's Name:
5. Date of Birth:  Pick a date
6. Sex: Male Female 7. Marital Status: M.     UM.
8. Nationality: 9. State if: NRI    Foreign Student
10. Present Mailing Address :
     City: District: State:
     E-mail address: Pin Code: Telephone:
11. Permanent Home Address:
     City: District: State:
     Pin Code: Telephone:    
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12. Give Applicable Educational Data as per Course Eligibility :
Sr.No. Examination Passed Year of Passing Board/Institute/University % of Marks
1.
2.
3.
4.
5.
13. (a)Whether Employed : Yes No
      (b)If Employed give Name of Employer
    (c)Working Experience (attach seprate sheet if required) :
Sr.No. Name of Organisation From To Post Held Remarks
1.
2.
14. Category Code for Fee Concession if applicable:
15. (a)Payment Details : Cash Draft/ChequeMoney Money Fund Transfer
      (b)Mode of Payment of fee: Get fees details click here
      Lumpsum Instalment: Scheme I Scheme II 
Name of Bank DD /Cheque/Cash / Money Transfer I.D. No.         Date of Issue/Deposit Amount
16. Have you enclosed : a) Registration Fee Yes No
  b) Postal Charges Yes No
  c) Examination Fee       Yes No
17. Option for Examination:   a) At examination Centre Lucknow
  b) Assignment Based Examination (Postal)
  c) On Line Examination
18. a) Have you opted for fast track system to complete the course. Yes No
      b) If yes, Have you enclosed fee for Fast Track System.                   Yes No
19. You came to know about this course through:
      (a) News Paper (b) IICT Student (c) Internet (d) Any other means
20. Choice of optional papers for MBA, MBA (Dual Spl.) and EMBA (Give Subject Code Only): Get Subject Code click here
  Semester I Semester II Semester III Semester IV
      a) MBA CT CT CT CT
      b) MBA (Dual Spl.) CT CT
Major CT CT CT
Minor CT CT  
CT
      c) EMBA (IInd Semester): CT CT CT
21. Enclose Self Attested copies of following Requared documents:
High School Certificate(10) :    Intermediate Certificate(10+2):    
Graduation Certificate :            Exprience Certificate if required:
Fee Concession Certificate :     Employment cerificate :             
Diploma Certificate :                Other :                                     
Fee Deposit Detail:                  
Instructions
Completed application form should be submitted to The Director, IICT, 5/28, Vikas Nagar, Lucknow-226022,. On The application form mention the details of the required fee (crossed Demand Draft drawn in favour of Indian Institute of Commerce And Trade payable at Lucknow or Counter foil of Electronic Fund Transfer Receipt).
Declaration
I have carefully read the Academic and Administrative Rules and Regulations of IICT for Correspondence Programmes as given in the information brochure and agree to abide by the same. I hereby declare that if I am enrolled in the programme applied, I agree to pay balance of fee instalments on specified dates. I further declare that the information provided by me in the application is true to the best of my knowledge and belief. A list of enclosures is attached with this application form.
Date  Pick a date Place