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  • IIMC Applicant Details Form

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    saurabh chaubey
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    This document is an application for admission to the Indian Institute of Mass Communication (IIMC). It contains details about the applicant such as name, date of birth, gender, nationality, category, address, education qualifications, work experience, guardian details, payment details, and declarations signed by the applicant. The applicant is applying for the Post Graduate Diploma course in Advertising and Public Relations in Hindi medium at the Delhi center.

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    This document is an application for admission to the Indian Institute of Mass Communication (IIMC). It contains details about the applicant such as name, date of birth, gender, nationality, category, address, education qualifications, work experience, guardian details, payment details, and declarations signed by the applicant. The applicant is applying for the Post Graduate Diploma course in Advertising and Public Relations in Hindi medium at the Delhi center.

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    9 views1 page

    IIMC Applicant Details Form

    Uploaded by

    saurabh chaubey
    This document is an application for admission to the Indian Institute of Mass Communication (IIMC). It contains details about the applicant such as name, date of birth, gender, nationality, category, address, education qualifications, work experience, guardian details, payment details, and declarations signed by the applicant. The applicant is applying for the Post Graduate Diploma course in Advertising and Public Relations in Hindi medium at the Delhi center.

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    5/13/2019 IIMC

    Applicant Details
    Unique Registration Number. IIMC/2019/13501
    Name of Applicant SHUBHAM KUMAR CHAUBEY Date of Birth (dd/mm/yyyy) 11/8/1998
    Gender Male Nationality INDIAN
    Category General Physical Handicapped No

    Photo Signature

    SAROJ KUMAR CHAUBEY S.K CHAUBEY,


    Corresponding Mailing Address NEAR SHIV MANDIR ,VISHWAKARMA Phone No.
    NAGAR,SUSUWAHI, VARANSAI VARANASI
    State UTTAR PRADESH Pin Code 221006
    Email-id shubhamchaubey441@gmail.com Mobile No. 9451908570
    Details for Course Applied & Centre
    Advertising and Public Relations
    Name of Post Graduate Diploma Hindi
    Medium of Exam
    Course: Hindi

    Indicate preference of IIMC


    1 - DELHI
    Choice Examination Centre : Centre for pursuing course in
    2 - LUCKNOW
    Journalism (English) :

    Applicant's Guardian Details


    Father's/Guardian's Name: SAROJ KUMAR CHAUBEY Mother's / Guardian's Name : MINU CHAUBEY
    Mother's / Guardian's Mobile
    Father's/Guardian's Mobile No: 9415623421 9451908570
    No :
    Profession of Mother /
    Profession of Father/Guardian: government housewife
    Guardian :
    Annual Family Income(In Rs.): 600000
    Education Qualification Details
    Graduation Result Awaited
    Qualification Board/University Passing year Percentage Name of the Institution Name of the degree
    10th CBSE 2014 64.6 Kendriya Vidyalaya NA
    Qualification: 12th CBSE 2016 75.8 Kendriya Vidyalaya NA
    Graduation MGKVP 2019 60 MGKVP BA
    Post Graduate

    Work Experience Details


    Designation: Name of Institution :
    Period : From: To:
    Payment Details
    Examination Fee: 1500.00 Payment Status : Payment Success of Rs. 1500.00
    Declarations
    I do hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any
    statement/information being found false/incorrect/incomplete or intelligibility being found before admission or after admission, my candidature will stand
    automatically cancelled.

    http://iimcdiplomacourses.asrb2014.org/PrintForm.aspx 1/1

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