NIIT Imperia Application Form for CPR Programs
Personal Details
 
 
Title First Name Last Name
Name *
Gender *  
Date of Birth *
 Calender
Nationality *
Address for Correspondence
Line 1 *
Line 2
City *
  (If Others)
State *
   Pin Code *
Landline Number (including STD Code)
Mobile Number *
Primary Email Id *
  Reconfirm Email Id *
Alternate Email Id
Total Annual Family Income In Rs.
Preferred Study Center*
Academic Details *
Last/Highest Academic Qualification Details :-
Exam
Area
Subject
Year
School / Institute
Board / University
% Marks
 

Employment Details *
Current Employment Details :-
Organization
From (mm/yy)
To (mm/yy)
Tot.Exp
(in months) 
Designation
at end
Role
Annual
Salary at end
(in INR)
   
 
Application Details
Program Name*  
Batch Code*  
Program Fee*                                          
Payment Mode*  
 
Declaration

I have gone through the Information Bulletin and the applicable Program Details. I declare that all information given and Statements made in this application and also its accompanying attachments and enclosures are true to the best of my knowledge. I agree if any information or statement is found to be incorrect, my application and subsequent admission will automatically be cancelled and no money will be refunded. I am also aware that the institute(s) concerned or NIIT Imperia may reject my application without assigning reasons for the same.

  
 
* Mandatory fields
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