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ONLINE ADMISSION APPLICATION FORM

Name of Course Applied*
 

 

Admission for the year*
 

 

Name*
 
 
 

 

Date of Birth*
 

 

Gender*
 
Male   Female

 

Name of Father / Guardian*
 
 
Occupation of Father / Guardian*
 

 

Permanent Address
 
 
 
Correspondence Address
 
 

 

Address*
 
 
Address*
 

 

City*
 
 
City*
 

 

State*
 
 
State*
 

 

Country*
 
 
Country*
 

 

Pin / Zip*
 
 
Pin / Zip*
 

 

Phone*
 
 
Phone*
 

 

Email*
 
 
Email*
 

 

Fax*
 
 
Fax*
 

 

Correspondence address same as Permanent address

Educational Qualification

Education*
 
 
Name of Board / University*
 

 

Subject(s)*
 
 
Total Percentage / Grade*
 

 

Year of Passing*
 

 

 

Education*
 
 
Name of Board / University*
 

 

Subject(s)*
 
 
Total Percentage / Grade*
 

 

Year of Passing*
 

 

 

Education*
 
 
Name of Board / University*
 

 

Subject(s)*
 
 
Total Percentage / Grade*
 

 

Year of Passing*
 

 

 

Hostel facility Required*
 
Yes   No
 
From where did u heard about APIM?*
 
Photo*
 

 

Family Details

Father Name
 
 
Mother Name
 

 

Age
 
 
Age
 

 

Occupation
 
 
Occupation
 

 

Total Household Income / Year
 
 
No. of Brother / Sister Earning
 

 

No. of Brother / Sister Studying
 

Declaration

I Mr./Mrs.*
 
 
Son of / Daughter of*
 
  • I assure that I will not indulge in any activity that would tarnish the image of the Institution.
  • I am aware that the management of APIM has every right to suspend / dismiss me from the institute or even debar in case I breach the code of conduct.
  • I am aware that the fee once paid will not be refunded under any circumstances.
  • I am aware that my admission is subject to the approval of APIM
  • All information provided above are true and verifiable to my knowledge.

I AGREE TO THE TERMS

Payment Details

Please tick the mode of payment*
 
DD   MO
 
Amount
 

 

Date*
 
 
Bank Name / Post Office*
 

 

Branch*