Application Format & Fee Structure 2012-13

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STATE INSTITUTE OF HOTEL MANAGEMENT

Sl. No.

District Tourism Centre, Balangir-767001 (Odisha).


Tele fax: - (06652) 230730, Email:-fcibgr@yahoo.co.in

APPLICATION FOR ADMISSION


For Office Use Only

Reg. No

Affix Passport Size


Photo

Roll No

COURSE APPLIED (Block Letters): 1.

Name of the Candidate:

2.

Fathers Name

3.

Date of Birth: - . 4. Age ...

5.

Male/ Female: . 6. Marital status:

7.

Whether SC/ST/Physically Handicapped:

(In Capital Letters)

:-.

(Attested photocopy of certificate from the competent authority to be enclosed)

8.

Nationality: 9. Annual Income: -

10.

Address for Communication:-

Phone No:-.

11.

Permanent Address: -.

Phone No:-.

12. Details of Examination Passed:


Examination
Subject
Passed

Percentage in
Aggregate

Year of Passing

I hereby declare that the particulars furnished in the application are true and correct to
the best of my knowledge.
Place:
Date:
Enclosures

Signature of the Applicant

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