| Name
                and Address of the Supervisor | _______________________________________________ _______________________________________________ _______________________________________________    | 
              
                | Is the Supersisor an Academic Counsellor of Management
                Programme of IGNOU
 | Yes
                _______________ No _____________________ | 
              
                | If Yes Name and Code of Study Centre and the courses he/she is
                counselling for and since when
 | _______________________________________________ _______________________________________________
 | 
              
                | No. of the student currently working under the supervisor for
                MS-100 (Please refer to point No.4 in the guidelines)
 | _______________________________________________ _______________________________________________ | 
              
                | Signature
                of Student Date | Signature of Supervisor Date:
                                      
                 |