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

Online Application Form

   
Program: *
Your residential location:*  
State: *
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)
(Communication Address)
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
Payment Mode:
 
Amount (Rs.1000 + GST 180)
   
 
I hereby undertake that the Certificates / Degrees / Mark sheets with regard to educational qualifications submitted by me are genuine. 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.