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Thingy

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M IS SI O NS

COMMON APPLICATION PROFORMA
F U L L T I M E PG / UG D I P L O M A P R O G R A M M E

AD

1. 2. 3.

Please enclose two copies of recent passport size photograph and paste one in the box alongside Also enclose an attested photocopy of your photo -ID (Ration card / Passport / PAN Card) Enclose a non-refundable fee of Rs. 1000/- for (PG/UG) by crossed bank draft (DD) payable at Delhi drawn in favour of “IIPM“

20 14

passport sizedphotograph

I WAN T TO A PPLY FOR ( TIC K T HE A PPR O PRIATE BOX)

 PG - Programme in Planning & Entrepreneurship - Post Graduate Diploma in Planning & Entrepreneurship - Triple Specialisation with Marketing and Economics as Compulsory Specialisation and One Elective Specialisation ( Finance/HR/IT ) + One Compulsory Super Specialisation ( Entrepreneurship )  UG - Integrated Programme in Planning & Entrepreneurship - Graduate Diploma in Planning & Entrepreneurship - Post Graduate Diploma in Planning & Entrepreneurship

Interview Centre  Bangalore  Chennai  Hyderabad  Delhi  Kolkata  Mumbai  Online

Study Centre  Bangalore  Chennai  Hyderabad  Delhi  Kolkata  Mumbai

- Triple Specialisation with Marketing and Economics as Compulsory Specialisation and One
Elective Specialisation ( Finance/HR/IT ) + One Compulsory Super Specialisation ( Entrepreneurship )

A. PERSONAL DATAILS:

  
Surname First Name Middle Name

A.2. Date of Birth: A.3. Sex: M  A.6. Nationality:

 (DD / MM / YYYY)
F A.4. Marital Status: Married  Single  A.5. Blood Group:




Y N If yes, expiry date:

A.7. Do you have a passport:

 (DD / MM / YYYY)

A.8. Father’s / Guardian’s Name (Please strike out whichever is not applicable)

  
Surname First Name Middle Name

A.9. Father’s / Guardian’s Occupation: _________________________________________

Contact No: _____________________________

Company Name: ________________________________________________ Exact Designation: _______________________________________ A.10. Mother’s Name (Please strike out whichever is not applicable)

  
Surname First Name Middle Name

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