NATIONAL INSTITUTE OF CONSTRUCTION

MANAGEMENT AND RESEARCH

SCHOOL OF DISTANCE EDUCATION

1. Name

RCC/EXAMINATION ENROLMENT FORM

December 12-24, 2011
: ________________________________________________________

2. Registration Number

: ________________________________________________________

3. Mailing Address

: ________________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Tel: _____________________ e-mail: _______________________

4. Course

: _____________________ Module _________________________

5. Centre

Regional Contact Classes: (December 12-16, 2011 )

Sr.
No.

Subject

Date

Presence
(Y/N)

Amount

D.D. No. & Bank &

Date
Branch

1.
2.

Rs. 2,500/-

3.
4.

Examinations: (December 17-20, 2011 )

Sr. No. Course No. Course Title

Module

Assignment Submitted

1.

Yes

No

2.

Yes

No

3.

Yes

No

4.

Yes

No

5.

Yes

No

6.

Yes

No

Computer Proficiency Programme: Pune and Hyderabad (December 21-24, 2011 )

I wish to enrol for the Computer Proficiency Programme of four days and paying the fee of Rs. 8,000/(Rs. Eight Thousand only).
Yes
No
D.D. No.
Date
Bank & Branch
Signature: ___________________
Date:________________________