Nomination Form

Note:

   1. It is mandatory to submit a statement of purpose along with nomination form.
   2. Please donot Use any special chanracter ( | ` ´ ¬ ¦ ! " £ $ $ % " < > : ; ~ ) in input.
   3. * are Compulsary Fields

 

TO BE FILLED IN BY THE NOMINEE
Full Name* :
Date of Birth :
Gender :
Age* :
Email* :
Fax :
Address for Communication* :
City*
Pin* :
Country* :
Phone (Office) :
Phone (Res) :
Mobile* :
Designation* :
Organization* :
Executive You Report:
Present Responsibilities :
Qualification* Degree Subject(s) Year College/University
Work Experience* Organization Position Years of exper. Gross Salary
Previous IIMA
Programmes Attended
Programme title Duration Year  
 
Other Programmes
Attended
Institution Programme title Year Duration  
 
Your Expectations from this Programme*
Details about Sponsor
Name of the Sponsor :
Designation:
Organization:
Tax Deduction Account Number (T.A.N.):
Permanent Account Number (P.A.N.) :
Address for Communication:
City
Pin
Country
Phone
Email
Fax
Information of Organization
Total Assets (last year)
Total Sales Turnover(Last Year)Numeric
Major Products / Services
Form of Organization
Please indicate the sources of information of CLLB (Facebook, Linkedin, IIMA website, etc...)*
STATEMENT OF PURPOSE*



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