Applіcatіon Form for

IPGD/PGD-AS/PGD-BA/PGD-A&AS2019 - 2020

Financial District, Gachibowli, Hyd-32. | Tel: 040-23000005 | E-mail: admissions@iirmworld.org.in | www.iirmworld.org.in

Application No :

Course Stream

International Post Graduate Diploma (IPGD)

Post Graduate Diploma (PGD)

Investment Planning & Life Insurance

General Insurance

Risk Management

Actuarial Science

Business Analytics

Analytics & Actuarial Science

Permanent Address :

City : State :

Communication Address :

Pin :

Pin :City : State :

Name :th (Name should be entered as in your Matriculation / 10 Class Certificate)

Personal Details

Recent Photo(Formals Only)

(Rs. Lakhs)

Date of Birth : Gender : Male Female DD / MM / YYYY

Marital Status : Single Married

E-mail Id : Contact No :

Father’s Name : Contact No :

Occupation : Organization : Approx. Annual Income :

Mother’s Name: Contact No. :

Father’s/ Mother’s E-mail Id :

(A Joint Initiative of IRDAI and Govt. of Telangana)

Approved by AICTE

Work Experience (if any)

Application Registration Amount :

Date :

Place :Signature of Applicant

Company : From To Designation

How did you come to know about IIRM

SSC / Matriculation / X Std.

Graduation / Degree

Experience (if any)

Intermediate / PUC / XII Std.

Score / Marks Card

Two Passport size Photographs

Cash / DD of Rs. 500/- to be drawn in favor of IIRM, Hyderabad

I have carefully read the instructions and agree to abide by the decision of Institute regarding my selection to program.

I certify that the information furnished in this application form is correct to the best of my knowledge and belief.

Declaration by the Applicant :

Academic & other Distinctions / Achievements / Extracurricular Activities

List of Enclosures : (Copy of Certificates)

Educational Details ( Starting with highest Qualification )

Qualification Board /

UniversityAggregatePercentage

Class /Division /

CGPA

Medium ofInstruction

Year

From To

Name of theSchool / College