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BILITY AND INTE

Chartered Institute of Management and Leadership
ware, Uni
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Delaw
Unitted States of Ameri
Americca

RSHIP APPLIC
ATION FORM
MEMBE
MEMBER
APPLICA
Please indicate which membership level you are applying for:
Graduate (Grad.CIML)

Associate (ACIML)

Full Member (MCIML)

Fellow(FCIML)

State/country where applied from……………………......................................……………………………………………………………..
Name of Student………………………………………………......................................................……………………………………………..
Date of Birth…………………………………….. Sex…………………………………… Marital Status……………...........……………………….
ADDR
ADDREESS
SSEES
Permanent home address:……………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………...............................……………
Address for Correspondence (if different from home address)………………………………………………………………..……………
.............…………………………………………………………………………………………………………………………………………………………………
Postal Code:……………………………............……… Tel:................................................... Fax:…………...........…………………….
Email:………………………………………................................................................................................................………………
(Particula
articularrs of Educ
ducaation)
School, College or other Secondary
Institutions Attended

Date
Qualification/Certificate Obtained
From

To

The Chartered Institute of Management and Leadership is incorporated and chartered under Delaware Code, Title 6; Chapter 18 of the state of Delaware
statues in the United States of America

USA? All applicants should note that the Institute reserves the right to make without notice changes in regulations. Ordinances and Regulations from time to time in force. Programme & Application fees once paid are not refundable. I have confirmed the affiliation status of the study center through the official website of the Institute(www. Polytechnic. the name and link of the study center is present in the list of Global Affiliates of the institute. USA and for the same I am submitting this form through the authentic study center of the Institute.Title Duties in Brief Period of Service Finding out about CIML: rs How did you fi firs rstt learn about CIM CIMLL. fees etc at any time before or after a candidate's admission.cimlglobal.University. College or other Higher Institutions Attended Course of Study Degree. All the information provided above in the form are true to the best of my knowledge. Title 6. Statues. courses.us). Admission to the Institute is subject to the requirement that the candidate will comply with the Institute's registration procedure and will duly observe the Charter. Chapter 18 of the state of Delaware statues in the United States of America . Diploma. Professional Qualification Obtained Date of Award nt hi (Emplo (Employyme men hisstory) Current Occupation Employer Position Held . The Chartered Institute of Management and Leadership is incorporated and chartered under Delaware Code. Decla Declarration from Appli Appliccant I am willing to apply for Membership of Chartered Institute of Management and Leadership.

2. I am an authentic affiliate/nominator of the Institute and the status of my affiliation with CIML. nts to be at Docume Documen atttached with this form: 1. 6. I would maintain the application records. I am nominating the applicant for aforesaid Membership grade of Chartered Institute of Management and Leadership. or formal actions as the case may be. study records.. I. USA and for the same I am submitting and signing this with the applicant. legal.) A detailed resume of the candidate Attested photocopies of work experience certificates The Chartered Institute of Management and Leadership is incorporated and chartered under Delaware Code. USA is available on its official website of the Institute (www. affiliations. I would abide by the rules and regulations of the Institute failure in which the institute may take disciplinary. and recognition as per its management decisions and is not focusing on any country specific accreditation/recognition. Decision of the Management of the institute would stay final in all cases. 4. The same has been shared with the applicant. I have seen all original documents and have put the attested photocopies of all documents in my records. Chapter 18 of the state of Delaware statues in the United States of America . would be solely responsible for acceptability of the earned certificate in the region of use. the applicant. All the information provided above in the form is true to the best of my knowledge. USA maintains its global accreditations. Decla at or Declarration from Nomin Nominat ator As on date. Title 6. I have confirmed the identity and eligibility of the applicant.us).cimlglobal. 5. like Passport/Driving License etc. 3.CIML. Signature and Stamp of Nominator: ……………………………… Date: ……………………………. and performance record of the candidate in my safe repository and will provide to the Institute if demanded anytime in future (up to 10 years). Two passport size photographs Attested photocopies of all educational certificates (10th onwards) Address Proof (Electricity Bill/Mobile Bill/Driving License/Credit Card Statement in the name of candidate only) Identity proofs (some document issued from State/Central Government only. Place: …………………………. Signature of Applicant: …………………………………… Date: …………………………….