THE INDIAN LAW INSTITUTE

(Deemed University)
Bhagwan Dass Road, New Delhi-110001
Website: www.ili.ac.in/ www.ilidelhi.org Email: e_ipr@ilidelhi.org

E-learning initiative

Application Form for online Certificate Course in Intellectual Property Rights and Information Technology in the Internet Age
1. Candidates Name (in Block Letters)... 2. Fathers/Husbands Name ... 3. Date of Birth .... (DD/MM/YYYY) .. Years Sex.

4. Postal address 5. Tel.(Res.).(mobile)E-mail. 6. Please specify Mode of Payment: [Online Payment/ Demand Draft] ________________ If payment made through Online Payment Gateway* : Transaction ID _________________________ Date of Transaction _________________ for Rs.4000/-(Rupees Four Thousand Only)
(*Please email copy of Payment Response page along with Application Form)

If payment made through Demand Draft Demand Draft No. .. dated . Bank for Rs.4000/- (Rupees Four Thousand only) in favour of The Indian Law Institute payable at New Delhi 7. Occupation 8. Designation... 9. Full name and address of office.. . Tel...Fax No.. E-mail 10. Details of examinations passed commencing matriculation
Examination Board/University Institution Year Division Marks (%) Subjects

11. If admitted, I undertake to abide by all the rules and regulations of the Institute, issued from time to time. Date . Place.
Instructions for filling the Application Form: 1. The Application Form can be downloaded from the ILIs web site (www.ili.ac.in or www.ilidelhi.org). 2. If payment of Rs.4000/- is made through Online Payment Gateway, send Application Form along with copy of Payment Response page duly generated by system after successful transaction through email only at e_ipr@ilidelhi.org.

Name & Signature of the Applicant

3. 4.

If payment is made through Demand Draft, send hard copy of the duly filled Application Form along with a draft of Rs.4000/drawn in favour of Indian Law Institute payable at New Delhi to the Registrar, Indian Law Institute, Bhagwan Dass Road, New Delhi-110001. Last date for the receipt of Application Form is 10.04.2012.