Shanti Devi Shiksha Samiti's

APPLICATION FORM (Delhi Govt.Regd.No.S-47035)

Neptune Institute of Management & Technology

Since 1995 (A Unit of Shanti Devi Shiksha Samiti, Regn. No. S-47035)
Established Under R.S. (XXI of 1860) Act. of Govt. of NCT of Delhi

Registration No......................................................... Session.........................................................

1. Name of Counselor City

2. Application for Admission to

3. Specialization in (Compulsory)

4. Full name in Block Letter

First Name Middle Name Last Name

5. Date of Birth (Day / Month / Year)

6. Male Female Married Unmarried

7. Nationality
Photo
8. Father’s/Husband’s Name

First Name Middle Name Last Name

9. Mother’s Name

First Name Middle Name Last Name

10. Address for Correspondence

11. Permanent Address

12. Tel No. (R)

(O)

(M)

(Fax)

13. E-mail
14. Academic Details :
(Examination taken list in chronological order including examinations with result pending)

Degree Name of the Exam. Date Subjects/specilization Result Grades/

Institution / college / school Month Year Percentage

15. Work Experience (Starting with the most recent one)

Name of the Organization Designation From - To

16. Exam Option From Home Study Center Online / e-mail

17. Payment Option Cheque Cash/Cheque/DD* Credit/Debit Card Online

18. Course Fee Rs. (In Words)

19. Fee Paid $ / Rs. (In Words)

20. Bank 21. Balance Fee Rs.

Amount No. Dated

22. Cheques/DD/CC Details : 1.

2.

3.
DECLARATION

I certify that all information provided on this application performa is complete and accurate. I agree to familiarize myself
with all the rules and regulations of the programme set forth by NIMT and abide by them. I would uphold the standards and
respect the principles of NIMT. I know, this Certificate Course is a Non - Credits, Non - Professionals, Autonomous & Self
Designed by the Institute. This course does not come under the purview of UGC, AICTE, DEC, University and any other State
Acts. On Behalf of this course I cannot get credits in Govt./Public Sector. This course is a Certificate of Excellence only.

Documents Attached
1
Signature of Candidate 2
3
4
Date.........................
5
Important Guidelines :- 6
7
1. 5% fee will be paid extra if fee paid in installments.
2. Xerox copy of Mark Sheets and Certificates in proof of all examinations passed should be attached. 8
3. The application form along with the Bank Draft should be sent to the institute through courier/speed post.
9
4. For more than one application xerox copy of this application performa can be used.
5. Please keep a xerox copy of this application performa for your record and reference. 10
6. Fees once paid will not be refundable under any circumstances.
7. DD/Cheque should be payable at Delhi (India)