Institute of Good Manufacturing Practices India
REGISTRATION FORM
Programme:
Mode:
Please Note:
1. Please complete all the information accurately.
2. If the institute rejects any application, full refund will be made.
3. It is assured that your data will be stored in a secure way and will only be shared with placement
and authorised government agencies upon your request. This form is a deemed consent for the
same.
4. For details for the programme, please visit [Link]
5. You are required to enclose soft (scanned) copies of all relevant testimonials along with the
registration form.
The completed registration form should be emailed to the Director, IGMPI, A-14/B, A Block, Qutab
Institutional Area, Near Old JNU Campus New Delhi-110067, India to email ID info@[Link]
18001031071 (Toll Free), Phone: +91 11 26512850
Application Details
Amount Rs.:
Demand Draft/CHQ No.:
Affix a recent
Dated:
coloured passport
Bank: size photograph
NEFT Reference no:
Registration Number
(Leave this space blank)
*Crossed DD or Cheque should be in favour of “Institute of Good Manufacturing Practices India”
payable at New Delhi. Please write your name and address at the back of DD/Cheque. Applicable
examination fee needs to be paid at the time of your admission itself along with the programme fee.
PERSONAL INFORMATION
1. Full Name:
2. Address of correspondence (in capital letters)
Postal code/Zip code
3. Mobile no.:
4. Date of Birth:
5. Gender:
6. Mother’s Name:
7. Father’s Name:
8. Email Id:
9. Phone no with STD code.:
10. Nationality:
11. Category:
(SC: Scheduled Caste; ST: Scheduled Tribe; PH: Physically Handicapped; EWS: Economically
Weaker Sections; Ex-servicemen)
WORK EXPERIENCE
12. Work Experience (If any)
i. Total work experience: Year Months
ii. List all your work
From To Total Name the Designation Brief job profile
completed organization
months
ACADEMIC QUALIFICATIONS
13. Pre-Bachelor’s Degree Examination(s):
Std. School/ Board/ Year % Marks Class/
Institute University completed Obtained Division
10th
High School
12th
Intermediat
e
14. Bachelor’s Degree Examination(s):
Degree Obtained Subject/Specialization
College/Institute University
Year Marks considered for award of Class/Division in Bachelor’s
From To
CGPA/ % of Marks obtained/ Grade
(DD/MM/YYYY) (DD/MM/YYYY)
15. Post-Graduation Degree/Diploma (if any):
Degree Obtained Subject/Specialization
College/Institute University
Year Subject % of Marks obtained
From To
(DD/MM/YYYY) (DD/MM/YYYY)
16. Professional qualification (if any):
Degree Obtained Subject/Specialization
College/Institute University
Year Subject % of Marks obtained
From To
(DD/MM/YYYY) (DD/MM/YYYY)
DECLARATION
I have carefully filled up all the information and agree to abide by the decision of the IGMPI, New Delhi authorities
regarding my registration. I certify that the particulars given by me in the form are true to the best of my
knowledge and belief.
Date Name:
Place Signature: