Professional Documents
Culture Documents
Jawaharlal Neheru.
Jawaharlal Neheru.
Tele
: 22123, 24663
Std Code
: 01374
Grams
: NIMOUNT
ISD Code
: 91 1374 22123
Fax
: (01374)-23344
: nimutk2004@gmail.com
Affix
Photograph
here
(1)
Affix
Photograph
here
(2)
1. Name____________________________________________________________________________________________________
2. Date of Birth______________(in words) ______________________________________________________________________
3. Occupation_______________________________________________________________________________________________
4. Permanent Address________________________________________________________________________________________
_________________________________________________________________________ Pin Code ______________________
Telephone with STD Code _________________________________ E-mail __________________________________________
5. Telephone with address and next of kin, Parent/Guardian (in the event of an accident)
Name___________________________________________________________________________________________________
Address__________________________________________________________________________________________________
_______________________________________________ Pin Code ________________ Telephone ______________________
STD Code ____________________ Fax ________________________ E-mail ________________________________________
6. Course Serial No. (a)_________________ (1st option) Commencing on ______________
(b)_________________ (1st option) Commencing on ______________
7. Course to be attended viz Basic/Advance/Adventure/Search & Rescue/ Method of Instruction/ Mountain Guide.
8. Details of Basic/Advance course previously attended with Grading_______________ (Attach a copy of Basic course
certificate for Advance course. Attach Advance course certificate for S&R /Guide and Courses).
9. Vegetarian or Non-Vegetarian. ______________________________________________
10. Training fee Rs ____________ is enclosed vide Bank Draft No. _____________________dated
________________________________________ (forward SBI Bank Draft only).
I have read the rules and regulations of NEHRU INSTITUTE OF MOUNTAINEERING, UTTARKASHI relating to the courses of
training in Mountaineering/Adventure/Search & Rescue/ Method of Instruction/ Mountain Guide and have fully understood
the meaning and significance of the same. The above entries have been made by me and they are true and correct.
Date________________
Signature of applicant_________________________
11. Nationality _________________________ ( in case of private candidate must be certified by Sub-Divisional Magistrate or
a Gazetted Officer).
Certified that I Know the applicant and confirm that he is an Indian National
Date________________________
Place_______________________
(with seal)
12. I hereby certify that all the entries are correct in every respect. In case of deaths, accident or injury of any form, the
Institute or any of its staff will not be held in any manner wholly or partially responsible.
Signature _____________________
Date 1. _________________
1. Applicant ____________________
Date 2. _________________
2. Parent/Guardian_______________
Next Page
To,
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
Duration____________________________________
Date of arrival at NIM________________________
Date of departure from NIM____________________
Fee Details: DD No_____________Dated_________
Amount____________is here by acknowledged.
Requirement( if any)
(a)_____________________
(b)______________________
Please submit the above within one month for final
confirmation.
Dated:
No. Trig:
OIC Training
NIM, Uttarkashi