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Application FOAM

For the exam

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shownmathew5
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17 views2 pages

Application FOAM

For the exam

Uploaded by

shownmathew5
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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D.H. Road,Jos Brothers Building, Jos Jn., Kochi - 682016.

Ph. : 0484 2362183, 2364183, 2368183. Mob. : 8157860361,E-mail : [email protected] www. iimscochin.com
Door No : 68D, Munnar - Adimaly Road, Near Anachal Petrol Pump, Anachal , Munnar - 685565
Phone : 04865 298183, 9074543320, 6282582735, Email : [email protected]
Kimi Building, Palakkad - Malampuzha Road, Near Fantasy Park, Malampuzha, Palakkad- 6788651
Phone : 0491 2815183 , 9995007729 , 6282587294. Email : [email protected]

APPLICATION FORM

ENROLMENT FORM NO.

COURSE ENROLLING FOR


CENTRE OPTED

Name ..................................................................................................Male/ Female................

Date of Birth......................................Place .......................................Nationality.......................

Caste................................................Religion............................................................................

Current Address ( for communication).......................................................................................

.......................................................................................District................................................

Pin........................................State.........................................Mobile No...................................

Permanent Address..................................................................................................................

City............................................Pin............................................State......................................

Passport No..................................Tel No..............................Mobile No....................................

Parent’s / Guardian’s Name.......................................................................................................

Occupation...............................................................Annual Income (Rs)..................................

Address......................................................................................................................................

Pin.........................State.................................Tel...............................Mobile..............................

Reference ( to Prominent citizens from neighbourhood)

1) Name.................................................................................................................................

Occupation..........................................................................Tel.........................................

Address..............................................................................................................................

II) Name..................................................................................................................................

Occupation..........................................................................Tel...........................................

Address................................................................................................................................
HOSTEL FACILITY - Required / Not Required

School / College attended Last

Name of Instiution Course Attended From (Year) To(Year) Passed or Failed

Professional Training / Practical Exparience, if any (from most recent)


Nature of Work / Designation Employers From To

Sl.No Languages Known Read Write Speak

MotherTongue.................................................................................................................................

How did you come to know about this course.................................................................................

........................................................................................................................................................

Reason for choosing this course....................................................................................................

.......................................................................................................................................................

Reference in IIMS ( if any )............................................................................................................

.......................................................................................................................................................

What are you planing to do after completion of this course. ?

job consultancy own project higher studies

This is to affirm that all information given above is true and that I have read and accepted the tearms and conditions.

Signature of Parent / Guardian


Date.

Signature of student

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