Nomination Entry

Instructions
  1. Please do not use any special character  ( | ` ! " $ $ % " < > : ; ~ ) in input.
  2. Please use + for additional row for adding more data.

PERSONAL PROFILE

Programme Title* :
First Name* : Last Name* :
Gender* : Nationality* :
DOB* : Age* :
E-mail(personal)* : E-mail(official) :
Mobile* : Phone :
Organization* :
Sector* :
Designation* :
Position of Nominee* :
Designation to Whom You Report* :
Present Responsibilities* :
Reason(s) for Joining the Programme and Expectations* :
Organisational Address* :
Country* : State* : City* : Pin* :
Residential Address
Country : State : City : Pin :

PROFESSIONAL PROFILE


Education
Degree Subject(s) Year University
Work Experience
Organization Position Years of Experience Gross Salary
Programmes Attended at IIMA  
Programme Title Duration Year
Programmes Attended Elsewhere  
Institute Programme Title Duration Year
Date :


TO BE FILLED IN BY THE SPONSOR

Name of Sponsor :
Designation :
Organization* :
GST Number : Permanent Account Number (PAN)* :
Office Address :
Country : State : City : Pin :
Mobile : Phone : Fax : Email :
Date :


Please Indicate the Sources of Information of This Programme

Source of Information :