Name*
Gender*
Father's Name*
Mother's Name *
Email of Applicant*
Mobile*
Date of Birth*
Marital Status
Correspondence Address*
Permanent Address*

PARENT / GURADIAN DETAILS

Occupation of Father or Guardian (if father is not the Guardian) :*
Designation*
Name and Address of Organization*
PIN*
Telephone
-
Do you require Hostel Accommodation?*

ACADEMIC QUALIFICATION

High School/ Secondary

Stream/ Subject
School/ College
Board University
Year
% Marks Secured

Intermediate/Higher Secondary

Stream/ Subject in Intermediate/Higher Secondary
School/ College in Intermediate/Higher Secondary
Board University in Intermediate/Higher Secondary
Year of Intermediate/Higher Secondary
% Marks Secured in Intermediate/Higher Secondary

Graduation Specify

Stream/ Subject in Graduation Specify
School/ College in Graduation Specify
Board University in Graduation Specify
Year in Graduation Specify
% Marks Secured in Graduation Specify

Post Graduation

Stream/ Subject in Post Graduation
School/ College in Post Graduation
Board University in Post Graduation
Year of Post Graduation
% Marks Secured in Post Graduation

Professional & Other Degree

Stream/ Subject in Professional & Other Degree
School/ College in Professional & Other Degree
Board University in Professional & Other Degree
Year of Professional & Other Degree
% Marks Secured in Professional & Other Degree

Note: Attested photocopy of the academic & other documents to be submitted at the time of Admission.

Percentage of CAT/ MAT/ ATMA/ ANY other Score Card *

WORK EXPERIENCE

Name and Address of Organization:
Period From
To
Designation:
Upload your Passport size Photograph (Max. Size 1 mb)*

DECLARATION BY THE APPLICANT


I hereby declare that the particulars furnished in this application form are correct to the best of my knowledge and belief. I will, upon admission to NIILM-CMS, adhere to the rules and regulations of the institution and strive to uphold its esteem by following the highest standards of moral, intellectual and social discipline. I hold myself responsible for the PROMPT PAYMENT OF ALL dues and fees as are required by the institution and fully understand that the institution shall be free to take penal action against me in the event(s) of any conduct of mine which is deemed to be contravening the statutes, norms, rules and regulations of NIILM-CMS