<div align="center">Online Admission Form </div>

Online Application Form for the Academic cycle July’2018

   
Program: *
Your residential location:*  
State: * Category:*
Gender: * Date of Birth:*
Candidate's Name: *  
(as per high school certificate)
Father's Name: *
(as per high school certificate)
Mother's Name: *
(as per high school certificate)
Line 1:*
Line 2:*
City:*
State:*
Pin Code:*
  Country Code: City Code Phone No:
Residence:
Country Code: City Code: Phone No:
Office:
Mobile: * This mobile number will be used for further communication.
Email: * This email address will be used for further communication.  
Line 1:*
Line 2:*
City:*
State:*
Pin Code:
List below in chronological order Certificate & Degrees you have been awarded/expect to be awarded, starting with the highest academic qualification.
Degree/Certificate school / college name  and Board/University/Institute Year of Passing Division Aggregate % of Marks
* * * * *
* * * * *
Graduation        
* * * * *
Post-Graduation        
Any Other        
              
List below in chronological order any work experience or other employment you have had since graduation.
Name & Address
of Employer  
Designation   Industry   Name& Designation of immediate supervisor   Dates Full Time/
Part Time  
From To
 
(Serving personnel of Army, Air Force , Navy and Coast Guard only): To be filled by defence personnel only.
Service Number:
Rank:
Date of Commission:
Armed Service:
Payment Mode:
 
Amount (Rs.)
   
 
I hereby undertake that the Certificates / Degrees / Mark sheets with regard to educational qualifications submitted by me are genuine. The Degree qualification submitted by me is recognized as per UGC norms to the best of my knowledge. In case any of these Certificates / Degrees / Mark sheets are not found to be genuine, my admission may be cancelled. In that event, I shall have no claim whatsoever with respect to the duration spent and the fee paid for the course undertaken by me. In that event, I shall also be liable for penal action under relevant provisions of law.

I hereby confirm that I have read all the rules and regulations as per the academic policy given in the prospectus and I agree to abide by them. IMT-CDL reserves the right to change the definitive details - All Policies, rules, regulations, fee structure, syllabus, facilities, addition/cancellation of centres etc. These are subject to review and change from time to time as per requirement. These changes shall be binding on me at all point of time.