APPLICATION FORM

LUXURY CONNECT
1.

FOR EXECUTIVE LUXURY PROGRAMS 2012- 13

Programmes Applied for: Please choose at least 1 option from the list given below and enter priority 1/2 pertaining to the chosen option(s) in the parentheses provided. Priority BUSINESS STREAM

S. No. Programmes

(i) (ii)

Luxury Business Management Program [LBM]

Delhi

( (

) )

Luxury Customer Experience Management Pogram [LCEM] Delhi

(ALL FIELDS SHOULD BE FILLED IN BLOCK LETTERS) 2. Registration No. [To be filled in by the office] PG / BP/ 2012 PERSONAL DETAILS 3. 4. 5. Name:|| (First Name) (Middle Name) (Last Name) Date of Birth : Gender : D Male D M M Y Y Y Y

Female Designation : ............................................ Designation : ............................................ Designation : ............................................

6. a) Current Employer : .......................................................... b) Previous Employer : .......................................................... c) Previous Employer : ..........................................................

7. a) E Mail Id : .......................................................... Alternate E Mail Id : ..................................................... ADDRESS DETAILS 8. (a) Present Address: City:State:..PIN: Telephone No.:MobileNo. (Applicants) (b) PermanentAddress: City:State:..PIN: Tel.No(withSTDcode,ifappl.):................MobileNo.(Applicants)
Please indicate your mailing address preference: Present Address Permanent Address

EDUCATIONAL QUALIFICATION Graduation: 9.

Stream

Year

College/ Institution

University

% age

10.

Work Experience : ..............

11.

Payment through Demand Draft/ Cheque/ PO: PaymentDetails:DDNo.Dated.AmountRs BankNameBranch

DECLARATION OF APPLICANT 12. I certify that the particulars furnished are true and complete in all aspects, and no information has been withheld. I understand that falsifying documents or information on this application may result in penalties up to and including immediate/permanent dismissal from the Program. I understand that misrepresentation, falsifcation of documents, and/or the withholding of requested information in regard to this application are serious offences that may result in prosecution. I accept that no changes will be entertained once the duly flled forms have been submitted and that should my application be submitted with incomplete forms it will be rejected.

13.

SignatureoftheApplicant Date:

APPLICATION FORM

LUXURY CONNECT

FOR EXECUTIVE LUXURY PROGRAMS 2012- 13

Programs

Registration Fee

Resource Material Fe e

Tuition Fee (exclusive of taxes)

1. Luxury Business Management

Program [LBM]

Rs. 10,000/Rs. 5,000/-

FREE FREE

Rs. 1,00,000/Rs. 50,000/-

2. Luxury Customer Experience

Management Pogram [LCEM]

Notes:
(1) In case, the Mode of payment is DD/ Cheque/ PO, then it should be in favor of LUXURY CONNECT LLP payable at New Delhi. Bank Transfers can also be made in the name of LUXURY CONNECT LLP, Kotak Mahindra Bank Ac. No: 4711157046 (2) At the time of admission, students are required to pay Registration Fee. No cancellation will be entertained post registration. (3) ServiceTax as per prevalent rate of 10.3% to be levied and will be payable along with Fee. (4) Any other Statutory tax as applicable, imposed by the Govt. of India or any statutory body, will be charged extra. (5) 2 passport size Photographs should be sent to us along with the filled Application Form. (6) Filled Application forms can be sent to us by email at academics@luxuryconnect.in or by post at Luxury Connect LLP, 402, Avalon Apts., MG Road, New Delhi 30, India. (7) Registration Fee is adjustable with Tuition Fee.