NIILM

Name of Employer

Designation

Key Responsiblities

Name of Employer

Designation

From mm/yy

Key Responsiblities

Total period of work experience (in months)

1. Personal Details

(*) - Star marked fields are essentially to be filled by the candidate.

Enter Cheque/Draft number
Name * Title * First Last (Optional)
Date Of Birth* / MM / DD YYYY
Correspondence Address
* Address Line 1

Address Line 2 (Optional)

* City

* State / Province / Region

* Postal / Zip Code

Country
Telephone - (STD Code) ### (Optional)
Mobile Number* 10 Digit mobile number

Email* In block letters
Permanent Address (Same as above)
* Address Line 1

Address Line 2 (Optional)

* City

* State / Province / Region

* Postal / Zip Code

Country
Telephone - (STD Code) ### (Optional)
Mobile Number* 10 Digit mobile number

Email* In block letters

2. Parent's Details
Father's Name*

Occupation*
Mother's Name*

Occupation*
Mobile/Phone(s) 10 Digit mobile no. (Optional)

Email In block letters

3. Details of Applicant's CAT/MAT/XAT/ATMA*

Form No.	Test Roll No.	Score	Percentile
CAT 2011
MAT-2011-12
XAT-2012
ATMA-2012

4. Academic Qualifications (Fill NA if not applicable)*

Qualification	Name of the Institute	University/Board	Stream	Subjects/ Specialisation	Percentage
Qualification	Name of the Institute	University/Board	Stream	Subjects/ Specialisation	1st yr	2nd yr	3rd yr	4th yr	5th yr	total*
Post Graduation
Graduation*
XIIth*
Xth*

6. Professional/Additional Qualifications (if any)

Qualifications	Name of the Institute	Univercity/Borad	Subjects/ Specialisation	Duration		DIV
Qualifications	Name of the Institute	Univercity/Borad	Subjects/ Specialisation	From mm/yy	To mm/yy	DIV

7. Employment and Work Experience

8. Give details of Extra Curricular Activities and Achievements*

Sports
Cultural
Literary
Commnity work
Others

9. (a) What does success mean to you? Mention 3 of your strengths and 3 areas of improvement in yourself.*

9. (b) Describe in brief your career objectives. Explain how this program at NIILM would help you to achieve them.*

10. Which of the following newspapers/magazines were source(s) of information about the NIILM program for you?*
Times of IndiaBusiness WorldIndian Managment
The HinduThe TelegraphDainik Bhaskar
ABPOutlookIndia Today
Hindustan TimesCometition Sucess ReviewDainik Jagran
Business TodayTribuneAny Other (please specify)

11. Please specify when did you come to know about NIILM-CMS PGDM Program*
Around the same time as applying for CAT/MAT/XAT/ATMA
Before taking the CAT/MAT/XAT/ATMA examination
Immediately after taking the CAT/MAT/XAT/ATMA Exam
Immediately after the CAT/MAT/XAT/ATMA Result Declaration
After getting the admission results from IIMS

12. Upload your picture*

Declaration by the Applicant
I hereby declare that the particulars furnished in this application form are correct to the best of my knowledge and belief. I will upon admission to NIILM-CMS, adhere to the rule of the institute strive to uphold its esteem by following the highest standard of morals, intellectual and social discipline. I hold myself responsible for the PROMPT PAYMENT OF ALL dues and fees as are required by institution and fully understand that the institution shell be free to take penal action against me in the event(s) of any conduct of mine which is deemed to be contravening the statutes, norms ,rules and regulation of NIILM-CMS

Note: Applicants need to carry their attested copy of transcripts and certificates at the time of interview and Group Discussion (GD/PI)

PLEASE ENSURE THAT YOU HAVE FILLED THIS FORM COMPLETELY IN ALL ASPECTS AND ANY MISSING INFORMATION MAY LEAD TO THE REJECTION OF YOUR APPLICATION FOR THE NIILM PGDM PROGRAM

(*) - Star marked fields are essentially to be filled by the candidate.

Sports
Cultural
Literary
Commnity work
Others