CMPP, NED Academy NED PIQC Institute of Quality

University of Engineering &

Technology

APPLICATION FOR ADMISSION

 Certified Quality Professional

 Certified Software Quality Management Professional
 Internal Lab Management System Audit

A. PERSONAL DATA
1. NAME : FATHER’S NAME :
Mr. Ms.
2. COMPANY:
3. ADDRESS (Office):
(Residence):
4. DATE OF BIRTH (Day/Month/ Year): 5. N.I.C. NUMBER:
6. HOME PHONE: 7. WORK PHONE:
8. FAX: 9. E-MAIL:

B. EDUCATION (Attach your credentials with the application)

14. GRADE /
12. DATES ATTENDED 13. NO. OF ACADEMIC YEARS
11. COLLEGE OR UNIVERISTY DIVISION
10. DEGREE
(Name City/Country) FROM TO
(Year) (Year)

C. SUMMARY OF PROFESSIONAL EXPERIENCE

17. START DATE 18. FINISH DATE
15. POSITION 16. EMPLOYER 19. YEARS IN POSITION
(Month/Year) (Month/Year)

TOTAL YEARS

D. TECHNICAL TRAININGS / COURSES

23. DATES ATTENDED
20. DESCRIPTION OF 21. INSTITUTE 22. DURATION FROM TO
TRAININGS/COURSES (Month/Year) (Month/Year)

E. PROFESSIONAL MEMBERSHIPS
24. TYPE OF MEMBERSHIP 25. PROFESSIONAL BODY 26. MEMBER SINCE
 F. EMPLOYER’S APPROVAL (in case the candidate is an employee)
7. I certify that the information provided by the candidate is accurate to the best of my knowledge.
8. I have no objection whatsoever on the candidate’s admission and participation in the course.
3. The course fee will be paid by The employer The Candidate

____________________________ ___________ ___________

EMPLOYER’S STAMP & SIGNATURE NAME DATE

I. CANDIDATE’S VALIDATION
I certify that the statements above including my attachments are accurate to the best of my knowledge. I hereby authorize the institute to verify any information
submitted.. I understand that any falsification of any information in this application or attachment may cause for rejection or withdrawal of certification.

I further agree to hold the NED & PIQC harmless from any additional liability in the event this application is rejected on the basis of information furnished to NED &
PIQC by me or third person which would make me ineligible.

I further agree to adhere to the NED & PIQC’s Code of Professional Conduct and, if I am certified, to meet the requirements of continuous certification.

_______________________ _____________________
APPLICANT’S SIGNATURE DATE

DOCUMENTS TO BE ATTACHED
(Please ensure that the following documents have been attached and tick appropriately)
1. Application Fee (Rs. 2000) Non – Refundable
2. Passport Size Photographs (Two)
3. Professional Degree(s) / Provisional Certificate(s) – Photocopies
4. Certificate(s) of training Courses – Photocopies
5. Bio-data / Resume

PIQC USE ONLY

CHECK POINTS
PERSONAL INFORMATION COMPANY INFORMATION REFERENCE DOCUMENTS FEES PAID
CHECKED BY: DATE:

(SIGNATURE)
REVIEW AND APPROVAL THE APPLICATION HAS BEEN REJECTED
REVIEW / APPROVER: DATE:

(SIGNATURE)

PIQC Institute of Quality NED University of Engineering & Technology

Address: D-63, Block 8, Address: Centre for Multidisciplinary Postgraduate Programme
Gulshan-e-Iqbal, (CMPP), NED Academy
Karachi NED University of Engineering & Technology, Main
Tel: 34973784 – 34822234 University Road,
Fax: 34990775 Karachi
E-mail: piqc@cyber.net.pk Tel: 99261261-8 Ext: 2297
Fax: 99261255
E-mail: ccee@neduet.edu.pk