NATIONAL INSTITUTE OF CONSTRUCTION MANAGEMENT AND RESEARCH

SCHOOL OF DISTANCE EDUCATION

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RCC/EXAMINATION ENROLMENT FORM

SEPTEMBER 19, 2015 - OCTOBER 01, 2015
Name
: ___________________________________________________
Registration Number : ___________________________________________________
Mailing Address
: ___________________________________________________
___________________________________________________
___________________________________________________
Tel:_________________ Email:_______________________
Course
: ____________________ Module:_____________________
Centre
: ___________________________________________________

Regional Contact Classes: (September 19-23, 2015)

Sr.
No.
1.

Subject

Presence
Y/N

Date

Amount

2.
4,161/3.
4.
Bank & Branch :_______________________________________________________________
D.D. No.__________________________________

Date :____________________________

Examinations: (September 24-27, 2015)

Sr.
No.
1.

Course No.

Course Title

Module

Assignment Submitted
Yes

No

2.

Yes

No

3.

Yes

No

4.

Yes

No

5.

Yes

No

6.

Yes

No

Computer Proficiency Programme: (September 28, 2015-October 01, 2015)

Yes

No

I wish to enroll for the Computer Proficiency Programme four days and paying the fee
of Rs. 17,100/- (Rupees. Seventeen Thousand One Hundred Only).
D.D. No.
Date
Bank & Branch

Date: _____________

Signature: _____________