Membership No:
       Roll No:
        (For Official Use Only)
         National Institute of Export Management          
         AG, Anandraj Villa,7, Second canal Cross Road, Gandhinagar, Adyar, Chennai-600 020
Application Form For Admission To Diploma/Professional Diploma/Master’s program
   (Please Fill in the form in capital letter)  

  1.Name of the Candidate : ........................................................................................................
Date Month Year
  2.Sex: Male Female 3. Date of Birth :

   4. Father’s / Husband’s Name :.................................................................................................
    
   5. (a)Address for Communication :............................................................................................
     
     ...............................................................................................................................................

     ..........................................................State:..............................Pincode:................................

   (b) Phone (With Code):............................................(c) e-mail Address:....................................

   6. Academic Qualification:........................................................................................................
      (enclose photocopy of certificate)  
   7. Professional Qualification:....................................................................................................
       (if any)
   8. Courses applied for   
                                   1.  ............................................................................................................ 
                                   2.  ............................................................................................................ 
                                   3.  ............................................................................................................
                                   4.  ............................................................................................................
                                   5.  ............................................................................................................

  9. Optional Subject Selected
      (Select One out of Twenty Six :
      Applicable for Export Management course only):.................................................................

  10. Fee Payment Details: 
  Total Amount of Fee Paid:........................................................................................................

  Demand Draft No:......................................................Date:.......................................................

                                                            Declaration
  I have read and understood the rules and regulations of National Institute of Export   Management and I do hereby agree to abide by the same.

  Place:
  Date :                                                                                               Signature of the Applicant
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