WELINGKAR nee og Prin L. N, Welingkar Institute of Management Development & Research (Diploma Division) Lathumns Napoo Road, Matunga Central, Mambsi $00 019 “el (022) 23724130677 (28178816 ¢ 2417487 Application Form for 1 Year / 6 Months Diploma Approved by DEC (Govt, of India) Aixeyour ssp size photograph Sign below inside the box (PLEASE FILL IN CAPITAL. LETTERS ONLY) Det] Course Nome DaMi TOI 7 DMT] “DHAMTT FATT DTM | OEM | DEM{ 1_DAPRI | Distance Learning{ } Evening Batch{ ] Sunday Batch[ } July 2008 [ } January20 [| ] 7,500 { J 10,700[ ] 20,000 |] 22800(} 1 Personal Deta's : — ‘Surame 7 Pept First Name | | Father / Husband's Name T Date of Bin Coy coy, TI ge /ommi yyyy Mother Tongue I LO Examination Type Oninet - Examination Cente SO I Tr PCP Centre tor osanceLesrina Postal Address Pineode Email Addross Res. Tel Mobile No. Examination I [ I Board University i | ‘Schoo! / College I r Year of passing Work Experience | Office Address I I Coo ‘Any Course done at Welingkars Course Name Rll No. c “Signature ‘Amount Rs. ark Director