Next Batch commencing from: 1st July 2012 Last Date for Submission of completed Application Form: 31st

May 2012 ADMISSI N ! "M "#$IS%"A%I N N & 'rogramme fficer* Di+loma 'rogramme In,ian Society for %raining - De.elo+ment Training House B-4 !utab "nstitutional Area# $e% &e'rauli (oad $e% Del'i ) * * + ,'ones: * --+.+// *# -+.0/ 0/ Fa1: * --+.+/+*/ 2mail: istd3nic4in 5 istdtrg3airtelmail4in 6ebsite: istddiploma4org 4 -4 <4 44 Full $ame: S'ri5Smt457umari: 8$AD/IA 9Surname: 'A"A$ 9First $ame: A''(I)A%I N N &

Affi1 'ere a stamp siEe ,'otograp' and attac' one more copA %'ic' %ill be affi1ed to Aour identitA card# issued bA t'e Diploma >ffice# %ill be reFuired for appearing at t'e e1amination.

'"A0IN 9&iddle $ame:

Fat'er;s5&ot'er;s5Husband;s $ame: '"A0IN88888888888888888888844 Date of Birt': 212012134288888888888888888888888448888888

9DA=: 9&>$TH: 9=2A(:

Address for ?orrespondence 9in Bloc@ Letters::

B2101* S/"I JI0DANI DA"S/AN* SA"AS5A%I BA6$ )" SS " AD* N#A" 0I0A ) ((#$#* '' SI%# S5AMINA"A7AN MANDI"* 0I"A" 85#S%9& 8888888884488888888888888888888888844 888888844 To%n5?itA: M6MBAI:888888888448888State: MA/A"AS%"A::8888888 ,in 1013038888888884 Telep'one: 9>ffice: 88888888888444(esidence 02;022;03<=38888888888884444 &obile:34302;0=33 88888888882mail:+aragga,hia>gmail&com888884488 04 Academic B ,rofessional !ualification: 9start %it' 'ig'est degree: CniDersitA5"nstitution A4 Southern New Hampshire University (SNHU) B4 Mum?ai 6ni.ersity Degree5Diploma MBA Duration 18 months =ear of ,assing 2010

Bachelor of #ngineering

1 years

133=

9Attested ?opies of CniDersitA Degree5,rofessional !ualification must be enclosed:

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,resent >ccupation: a4 b4 Designation Management %rainer8888888888888888888888444 $ame B Address of 2mploAer >rganisation Self2#m+loye,8888888884488444 88888888888888888888888888888888888888

Date:

9Signature of Applicant:

5-5 /4 Details of #x+erience: "n case of Graduate Degree or its eFuiDalent# and 'aDe a minimum t%o Aears %or@ e1perience in Training5Human (esource DeDelopment function# attested bA Department 'ead must be attac'ed separatelA or giDen 'ere: >rganisation $A&2: D2S"G$AT">$: Attested bA Department Head : S"G$ATC(2 A$D S2AL .4 a: 2nclosures: 1& Bachelor of #ngineering Degree )ertificate 2& M&B&A Degree )ertificate 4
b: " also enclose 'ere%it' : i: ii: iii: (s4 <**5- to%ards ,rospectus Fee4 (s4 0**5- to%ards (egistration Fee (s4-0#***5- to%ards full ?ourse fee5 (s4 -#/**5- to%ards First "nstalment of ?ourse Fee4 "n case of Armed Forces >fficials and S?5ST candidates (s4-*#***5- to%ards full ?ourse fee5(s4 *#-**5- to%ards First "nstalment of ?ourse Fee4 Demand Draft $o88888884dated 8888844for (s888884 T'e Draft s'ould be in faDour of @IS%D 8Di+loma 'rogramme9A +aya?le at NeB Delhi If you are eligi?le* you can maCe a single ,raft for the total amount

,ost 'eld Training Functions

21perience =ears &ont's

iD: .9

H4

" certifA t'at t'e aboDe particulars are correct to t'e best of mA @no%ledge4

Date: 88888888 ! " !!I)# 6S# N(7

9Signature of Applicant:

StatusI Training 21perience ?ertificate52d4 ?ertificate 9s: reFuired AD&"T5 $>T 2L"G"BL2

Director 9T B D: "STD

,rogramme >fficer Diploma ,rogramme