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NOMINATION FORM
(for short duration open programmes only)
Designation: Experience:
Management Junior Middle Senior Top
Total no.years:
Phone:
Emails:
Mobile:
ORGANISATION DETAILS
Organisation type:
PSU
Public co
Private co
Central Govt
Organisation Name:
Organisation Address:
Phone:
Fax:
E-mail:
SPONSOR DETAILS
Name:
Designation: Official Address: Phone: Fax: E-mail:
Accommodation:
JOINING INFORMATION
(If the programme is not compulsorily residential)
Required
Not Required
DD drawn on bank:
bearing No:
Favoring Indian Institute of Management Bangalore towards programme fee for Rs.
Organisation
Self
How did you first hear about this Programme? Please Indicate the HR/Training Head to whom we should send future programme brochures:
Newspaper,
Magazine
Name:
Designation: Address:
Phone:
empt from
IIMB is exempt from payment of IT. Kindly do not deduct IT at source. Duly completed nomination form/s may please be sent to: The Administrative Officer (EEP) Indian Institute of Management Bangalore, Bannerghatta Road, Bangalore- 560 076 Ph: 080- 26993264/ 3475/26993742 Fax: 080- 26584004 /26584050 Email: openpro@iimb.ernet.in OR edp@iimb.ernet.in Website: www.iimb.ernet.in