Your Application Number:
Name & Address of Candidate:
Pin-
Payment Mode:
Credit/Debit Card
Affix your latest passport size, self-attested color photograph
(Signature of the Candidate)
NOTE: Please send Tear-off sheet along with required documents to:
Institute of Management Technology - Centre for Distance Learning
A-16, Site-3, UPSIDC Industrial Area
Meerut Road, Ghaziabad.
Form No:
Course:
Examination Centre:
State:
Category:
Gender:
Date of Birth:
Candidate's Name:
Father's Name:
House No:
Street:
City:
State:
Pin Code:
Country Code:
City Code:
Phone No:
Residence:
Country Code:
City Code:
Phone No:
Office:
Mobile:
Email:
House No:
Street:
City:
State:
Pin Code:
List below in chronological order Certificate/Degree/Diplomas you have been awarded/expect to be awarded, starting with the highest academic qualification.
Degree/Diploma/Certificate
Board/University/Institute
Year of Passing
Division
Aggregate % of Marks
10th
12th
Graduation
Post-Graduation
Any Other
(Note: Copies of all documents required to be submitted alongwith admission form must be attested by a Gazetted Officer)
List below in chronological order any work experience or other employment you have had since graduation.
Name & Address
of Employer
Designation
Nature of work
Dates
Full Time/
Part Time
Total
Monthly
Emoluments
From
To
(Serving personnel of Army, Air Force and Navy only): To be filled by defence personnel only.
Service Number:
Rank:
Date of Commission:
Armed Service:
Payment Mode:
Amount (Rs.)