GENERAL MANAGEMENT PROGRAMME FOR EXECUTIVES (GMPE) (with 250 hours of teaching in Five On Campus Modules )

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Indian Institute of Management Lucknow GENERAL MANAGEMENT PROGRAMME FOR EXECUTIVES (GMPE) 2018 19 (with 250 hours of teaching in Five On Campus Modules ) APPLICATION FORM

Instructions and Guidelines for Admission 1. The candidate will be short listed for selection in the programme unless s/he has a Graduation or Post Graduation (or equivalent) in any discipline with minimum 50% aggregate marks (or CGPA of 5 on a 10 point scale) or CA/ICWA/CS and a minimum of 3 years full-time post qualification professional experience as on July 06, 2018 2. It is very important that all candidates should carefully read the procedure and follow the steps for admission of GMPE 2018-19 programme. Kindly call us if instructions are not clear or you have a specific issue. 3. The Institute reserves the right to cancel / postpone the programme. Admission Procedure 1. Fill up the application form and send the same along with the self-attested photocopies of testimonials/official transcripts (educational and work experience certificates) and application fee of Rs. 2000/- (Rupees Two Thousand) (non-refundable) either as Demand Draft drawn in favor of Indian Institute of Management Lucknow, payable at Lucknow or via NEFT to the following Bank Account details. Beneficiary Name Indian Institute of Management Lucknow SB Account No. 07231450000294 Bank Name HDFC Bank Limited A R Centre, Dr. B N Verma Road, Opp. Gulmohar Hotel, Bank Address Lucknow - 226018 Bank Branch Aminabad Branch IFSC Code HDFC0000723 In case of NEFT/RTGS transfer, 1. Candidate Name: 4. Transaction Amount: please email following details to 2. Unique Transaction No. (UTR): 5. Bank Name: gmpe17@iiml.ac.in and mdpfin@iiml.ac.in 3. Transaction Date: 6. Branch Name: 2. Application Form along with application fee of `2000/- should reach The Programme Manager (Academic Services), Indian Institute of Management, Prabandh Nagar, IIM Road, Lucknow 226013 on or before July 06, 2018. 3. The admission team will shortlist candidates based on past academic performance, work experience and personal interaction (Interview). 4. Last date of Acceptance Fee is August 03, 2018. 5. Kindly present all original testimonials/official transcripts (educational and work experience certificates) at the time of admission for verification. The originals shall be returned after verification. Fee Structure The total course fee of the GMPE 2018-19 programme is `5,50,000/- (Rupees Five Lakh Fifty Thousand only) excluding of GST @ 18% or as applicable as per Govt. of India guidelines. The course fee is to be paid as per the following schedule: Fee Details Last Date of Fee Payment FEE (`) GST @ 18% (`) Fee including GST (`) Application Fee At the time of Application 2,000/- Acceptance Fee August 03, 2018 1,00,000/- 18,000/- 1,18,000/- 1st Installment August 13, 2018 1,50,000/- 27,000/- 1,77,000/- 2nd Installment November 12, 2018 1,50,000/- 27,000/- 1,77,000/- 3rd Installment April 01, 2019 (optional) 1,50,000/- 27,000/- 1,77,000/- Total 5,50,000/- 99,000/- 6,49,000/- The fee does not cover the international air travel, visa fee and health insurance, which will be borne by the participants/organization(s).

General Management Programme for Executives (GMPE) 2018-19 (With 250 hours of teaching in Five On Campus Modules ) with 5 days learning component at AIT Bangkok (optional) APPLICATION FORM Instructions: 1. Complete the application form in CAPITAL letters only. Use common abbreviations for courses, degrees, certificates, university names, etc. 2. In all matters relating to admission, the decision of the Indian Institute of Management Lucknow (IIML) will be final and binding on the applicant. No correspondence will be entertained from the applicant regarding his/her non-selection. 3. Self-attested photocopies of testimonials/official transcripts and application fee of Rs. 2000/- (Rupees Two Thousand) (non-refundable) either as Demand Draft drawn in favor of Indian Institute of Management Lucknow, payable at Lucknow or via NEFT as per the details given above, should be submitted along with the filled-in application. 4. The applicant will be required to present all original testimonials / official transcripts at the time of admission. 5. This form is a key part of the admission process. Complete and accurate information is, therefore, extremely important. Incomplete or false information will make your candidature null and void. APPLICATION FEE DETAILS AMOUNT Rs.2000/- DEMAND DRAFT NO. / UTR NO. DATED (DD/MM/YYYY) / / 2018 BANK NAME Paste recent passport size photograph 3.5 cm X 3.5cm A. PERSONAL DATA A1. Name (First Name) (Middle Name) (Last Name) A2. Gender Male Female A3. Date of Birth DD MM YYYY A4. Address for correspondence A5. E-mail id: A6. Telephone No. with STD Code Cell phone No. A7. Nationality

B. PROFESSIONAL FULL -TIME WORK EXPERIENCE B1. Total Work Experience as on July 06, 2018 Years Months and Days B2. Provide the following details of your work experience starting with your current employment. Do not include training, project work, work done as an integral part of curricular requirement, and part-time work. From (DD/MM/YY) To (DD/MM/YY) Total completed Months Name of the organization Designation B3. Are you sponsored by your organization: Yes No

C. ACADEMIC QUALIFICATIONS C1. Pre-Bachelor s Degree Examination(s): Std. School / Institution Board / University Year completed 10 th Max. Total % Class/ Division 12 th C2. Bachelor s Degree Examination(s): Degree College/Institute Subject/ Specialization University Year 1 st Year 2 nd Year 3 rd Year 4 th Year 5 th Year Date From To Max. / Max. GPA /GPA % Total / CGPA Class / Division Awarded C3. Master s Degree / Post-Graduation: Degree College/Institute Subject/ Specialization University 1 st Year 2 nd Year From Year To Subject Max. % of Overall percentage of marks obtained C4. Any other professional qualification (or Additional Degrees): Qualification College / Institute Programme Name & Duration

D. FROM WHERE DID YOU LEARN ABOUT THIS PROGRAMME? 1. LinkedIn 2. Advertisement in Newspaper 3. IIML website 4. Referred by friends / IIML alumni 5. Any other (please mention) E. ADDITIONAL INFORMATION, IF ANY F. REFERENCES Please provide the names and contact address of the persons for reference, who are well acquainted with your intellectual abilities and professional achievements and may be contacted, if required. Sl No. Name Address, Phone Number, E- mail 1. 2. G. DECLARATION I have carefully read the instructions and agree to abide by the decision of the Indian Institute of Management Lucknow authorities regarding my selection for the programme. I certify that the particulars given by me in this form are true to the best of my knowledge and belief. I know that at any time if the information furnished by me is found incorrect my candidature will be cancelled immediately. Place: Date: Signature of Applicant

H. STATEMENT OF PURPOSE Describe your career goals and your reasons for wishing to undertake GMPE course at Indian Institute of Management Lucknow (Max 100 words). Name: Signature: Note: Send the complete application form along with application fee latest by 5:00 PM by Friday, July 06, 2018 to the following address: Programme Manager (Academic Services) Indian Institute of Management Lucknow, Prabandh Nagar, IIM Road, Lucknow 226 013 (UP) India Phone: 91-522- 6696287/6696282/6696283 E- Mail: gmpe17@iiml.ac.in IIM Lucknow website: www.iiml.ac.in