Application No.: 2


PLEASE PROVIDE THE FOLLOWING DETAILS :

PERSONAL INFORMATION

PROGRAM APPLIED FOR :
FIRST NAME :
MIDDLE NAME :
LAST NAME :
POSTAL ADDRESS (INCLUDING THE PIN CODE) :
DATE OF BIRTH : eg:17/04/2000
GENDER : MALE FEMALE Other
ETHNICITY/RACE :
NATIONALITY :
RELIGION(OPTIONAL) :
TELEPHONE NO. (INCLUDE COUNTRY AND AREA CODES) :
CELL PHONE NO :
OFFICIAL ID NUMBER :
PLACE OF ISSUE :

ADDITIONAL INFORMATION

NAME OF THE PARENT/GUARDIAN: :
POSTAL ADDRESS OF THE PARENT/GUARDIAN :
PHONE NUMBER OF THE PARENT/GUARDIAN :
CELL NUMBER OF THE PARENT/GUARDIAN :

EDUCATIONAL BACKGROUND :

Name of the college and location
(from the most recent)
Period
(From - To)
Course Major subjects studied Secured Grade

WORK EXPERIENCE:(Most Recent First)

Job Title Company From To MAJOR TASKS HANDLED ANY OTHER INFORMATION IN SUPPORT OF YOUR ADMISSION
HOW DID YOU COME TO KNOW ABOUT RIMSR, AND THE COURSES OFFERED? :

DECLARATION

I DO HEREBY DECLARE THAT I WILL ABIDE BY THE RULES, REGULATIONS AND ORDERS FRAMED OR PASSED BY RIMSR FROM TIME TO TIME. THE INFORMATION GIVEN BY ME IN THE APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT I WILL BE HELD RESPONSIBLE IF ANY INCORRECT OR WRONG INFORMATION IS GIVEN HERE, AND IN WHICH CASE MY ADMISSION IS LIABLE TO BE CANCELLED AUTOMATICALLY. IN SUCH A CASE THE DECISION OF THE DIRECTOR, RIMSR IS FINAL AND BINDING.


Upload Photograph   :

Upload Official Id   :

Upload Degree Certificate: (Student pursuing a degree program may upload latest marks credential)

Signature of Applicant:   

Place   :

Date   :eg:17/04/2000

Enter Verification Code:


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