National Institute of Planning & Technology


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Personal Details

Full Name in Block Capitals: *

(Surname)

(First Name)

(Father's/Husband's Name)

Date of Birth:

(DD/MM/YYYY) According to School Leaving Certificate

Sex:

Nationality:

Father’s/Husband’s Name:

(Surname)

(First Name)

(Last Name)

Permanent Address:

(City)

(Post Code)

Correspondence Address:

(City)

(Post Code)

Telephone No. :


(Residence)		(Office)

*		*
(Mobile)		(Email)

Academic Details: List Highest Qualification First

Qualification	Year of Passing	Board /University	Grade	SPL (If any)

Work Experience: List Current Employment First

Name of Company	From	To	Designation	Address

Course Enrolled:

Name of the Course:

Specialization (If any):

Candidate Declaration:

I hereby declare that I have read and understood the condition of eligibility for the program for which I am seeking admission. I fulfill the minimum eligibility criteria for this program as prescribed in the prospectus. I have provided necessary and relevant documents. In the event of any Information being found incorrect or misleading, my candidature shall be liable to cancellation by the institute at anytime and I shall not be entitled to refund of fees paid by me to the institute as printed in the prospectus and I accept them and shall not raised any dispute in future over the same.

Dated:	(DD/MM/YYYY)

Location:

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Checklist of Document

Before Submitting the application form please make sure that you have affixed your photographs and signed over it and attached the following (tick the relevant documents):-

1) Passport size photographs (four)

2) Certificate in support of educational qualification, duty self attested

3) Work experience certificate starting period of employment, designation and duration of employment

4) Updated copy of the curriculum vitae/ bio data