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Application Form - Iimt

This document contains an application proforma for admission to the International Institute of Management and Technical Studies. The proforma requests information such as the applicant's name, date of birth, gender, nationality, contact details, academic qualifications, professional experience, examination option, payment details, and declaration. It also provides instructions that application fees are non-refundable, copies should be retained, correspondence requires a reference number, and payment should be by cheque or DD made out to the institute.

Uploaded by

Prateek Singh
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
16 views

Application Form - Iimt

This document contains an application proforma for admission to the International Institute of Management and Technical Studies. The proforma requests information such as the applicant's name, date of birth, gender, nationality, contact details, academic qualifications, professional experience, examination option, payment details, and declaration. It also provides instructions that application fees are non-refundable, copies should be retained, correspondence requires a reference number, and payment should be by cheque or DD made out to the institute.

Uploaded by

Prateek Singh
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION PROFORMA

Bhart i Lokseva Charit able Trust s

International Institute of Management and Technical Studies


Ena bling Growth through Education

1.

Applica tion for Admission for :

2.

Specia liza tion in (Compulsory):

3.

Additiona l Specializa tion / Extra Specia liza tion:

4.

Full Na me in BLOCK Letters:

Fir st N a m e

M iddle N a m e

La st N a m e

5.

Da te of Birth (dd / mm / yyyy): _____/ _____/ ________.

6.

Gender / M. Sta tus:


Ma le
Fema le

7.
8.
9.

Na tiona lity
Fa ther's / Husba nd's Na me
Address for Correspondence

Ma rried

Unma rried

: ___________________________________________________
: ___________________________________________________
: ___________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
City:________________________________________________

10. Perma nent Address

: ___________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
City:________________________________________________

11. Telephone No :

Residence
Mobile
Office

:______________________________________
:______________________________________
:______________________________________

12. Ema il ID.:_______________________________________________________________________________


13. Aca demic Deta ils:
Degree

School/College/Institution/University

Exam Year Main Subjects

Grade
/Percentage

APPLICATION PROFORMA
14. Professiona l Experience (Tota l Exp.,
Current Employer, Current Designa tion):________________________________________________

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
15. Exa mina tion Option :
16. Fees Pa id
Online

Residence

/ Study Center

Rs._______________________
Ca sh

US$________________________

Cheque/ DD
Cheque/ DD No:_________________________
Da ted :____/ _____/ _________
Ba nk :______________________________

17. Decla ra tion by the Ca ndida te :


I Cert ify t hat all t he inform at ion provided in t his applicat ion proform a is com plet e, t rue
& accurat e. I Shall abide on all t he rules and regulat ions define for t he appeared
program by I I MT.

Dat e : ____________________

Signat ure: _____________________

Place : ______________________

At t est ed Xerox copy of Marksheet s and Cert ificat es for all t he exam inat ions cleared.
Fees once paid will not be refunded or t ransferred t o any ot her nam e.
St udent s need t o ret ain a Xerox copy of t he subm it t ed applicat ion Perform a.
All correspondance need t o have t he adm ission reference num ber.
CHQ or DD. Should be m ade in favour of I n t e r na t iona l I nst it ut e of M a na ge m e nt
a nd Te ch nica l St udie s .

---------------------------------------------------------------------------------------------------------

FOR OFFI CE USE ON LY


Re fe r e nce # ________________________________________________________________
Re m a r k s

# _______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Dat e

# ____/ ____/ _______

Signat ure: ________________

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