Institute of Good Manufacturing Practices India
Global accredited training & certification provider
Approved by Quality Council Of India (QCI), Government of India
An ISO 9001:2008 Certified Organisation
Registered under The Societies Registration Act,1860 Government of India
Empanelled under Ministry of Horticulture and Food Processing, Government of Uttar Pradesh
International Register of Certificated Auditors (IRCA) accredited Lead Auditor (FSMS) course
Conferred with QUALITY COUNCIL OF INDIA (QCI) D.L. SHAH NATIONAL QUALITY AWARD Certificate of Merit 2015
New Delhi | Noida | Hyderabad | Lucknow
REGISTRATION FORM
Programme:
Mode:
Location (New Delhi | Noida | Hyderabad | Lucknow):
Please Note:
1.
2.
3.
4.
Please complete all the information accurately. Incomplete or false information may make your candidature null and void.
The decision of the Institute will be final and binding on the applicants in all the matters relating to registration.
For details of the Programme, please visit [Link].
You are required to enclose self-attested photocopies of all relevant testimonials along with the registration form.
The completed registration form should be sent by a registered post or couriered to the Director, Institute of Good
Manufacturing Practices India (IGMPI), H-119, Sector-63, Noida-201 307, Delhi National Capital Region (NCR), India, Phone:
+91 8130924488, +91 8587838177, +91 120-4375280
Registration Number
APPLICATION FEE DETAILS*
AMOUNT Rs.
(Leave this space blank)
DEMAND DRAFT/CHQ NO.
Ax a recent
coloured passport
size photograph
DATED
BANK
*Crossed DD or cheque should be in favour of Institute of Good Manufacturing Practices India
payable at New Delhi. Please write your name and address at the back of DD/Cheque. Applicable
examination fee can be paid later as per the Institute's examination notification.
PERSONAL DATA
1. Name
(First Name) (Middle Names)(Last Name)
2. Gender
Male
Female
3. Date of Birth
DD
4. Age : Years
MM YYYY
Months
5. (a) Address for correspondence (in capital letters)
Postal code/Zip code
5. (b) Permanent Address (in capital letters)
Postal code/Zip code
6. E-mail id :
7. Contact Telephone No. with STD Code
Phone No.
Mobile No.
8. Nationality
SC ST
9. Category (SC: Scheduled Caste; ST: Scheduled Tribe; PH: Physically Handicapped;
EWS: Economically Weaker Sections; Ex-servicemen; Attach copy of SC/ST/OBC,
PH, EWS, Ex-servicemen, Defense personnel, certificate as applicable for 10% fee
concession)
ExOBC PH EWS Service GEN
men
WORK EXPERIENCE
10. Work Experience (if any)
i) Total Work Experience
ii) List all your work
From
To
years
months and
Total
Complete
d Months
Days
Nam
e the
Organization
days
Designation
Brief Job Profile
ACADEMIC QUALIFICATIONS
11. . Pre-Bachelor's Degree Examination(s):
Std.
th
10 /
High School
th
12 /
Intermediate
/
Senior Secondary
School / Institution
Board/ University
Total
Max.
Marks
Year completed
Marks Obtaine
d
% Marks
Obtaine
d
Class/
Division
12.
Bachelor's Degree Examination(s):
Subject /
Specialization
Degree Obtained
University
College/Institute
Year
Date
To (DD/MM/YYYY)
From
(DD/MM/YYYY)
13.
Marks considered for award of Class/Division in Bachelor's
Degree
CGPA/ % Marks Obtained/ Grade
Post-Graduation Degree/Diploma (if any):
Subject /
Specialization
Degree
Obtained
University
College/Institute
Year
From
To
Subject
(DD/MM/YYYY) (DD/MM/YYYY)
Max.
Marks
Marks
Obtained
Max.
Marks
Marks
% of Marks
Obtained Obtained
% of
Marks
Obtaine
d
Overall percentage of marks obtained
14.
Professional qualification (if any):
Degree
Obtained
Subject /
Specializa
tion
College/Institute
University
Year
From
(DD/MM/YYYY)
To
Subject
(DD/MM/YYYY)
Overall percentage of marks obtained
DECLARATION
I have carefully filled up all the information and agree to abide by the decision of the Institute of Good
Manufacturing Practices India, New Delhi authorities regarding my registration. I certify that the particulars given by me
in this form are true to the best of my knowledge ant and belief.
Date
Place
d4433 400
Signature of Applicant
