Institute of Good Manufacturing Practices India

Global accredited training & certification provider

Approved by Quality Council Of India (QCI), Government of India
An ISO 9001:2008 Certified Organisation
Registered under The Societies Registration Act,1860 Government of India
Empanelled under Ministry of Horticulture and Food Processing, Government of Uttar Pradesh
International Register of Certificated Auditors (IRCA) accredited Lead Auditor (FSMS) course
Conferred with QUALITY COUNCIL OF INDIA (QCI) D.L. SHAH NATIONAL QUALITY AWARD Certificate of Merit 2015

New Delhi | Noida | Hyderabad | Lucknow

REGISTRATION FORM
Programme:
Mode:
Location (New Delhi | Noida | Hyderabad | Lucknow):

Please Note:
1.
2.
3.
4.

Please complete all the information accurately. Incomplete or false information may make your candidature null and void.
The decision of the Institute will be final and binding on the applicants in all the matters relating to registration.
For details of the Programme, please visit www.igmpiindia.org.
You are required to enclose self-attested photocopies of all relevant testimonials along with the registration form.
The completed registration form should be sent by a registered post or couriered to the Director, Institute of Good
Manufacturing Practices India (IGMPI), H-119, Sector-63, Noida-201 307, Delhi National Capital Region (NCR), India, Phone:
+91 8130924488, +91 8587838177, +91 120-4375280
Registration Number

APPLICATION FEE DETAILS*

AMOUNT Rs.

(Leave this space blank)

DEMAND DRAFT/CHQ NO.

Ax a recent
coloured passport
size photograph

DATED
BANK

*Crossed DD or cheque should be in favour of Institute of Good Manufacturing Practices India

payable at New Delhi. Please write your name and address at the back of DD/Cheque. Applicable
examination fee can be paid later as per the Institute's examination notification.

PERSONAL DATA
1. Name
(First Name) (Middle Names)(Last Name)
2. Gender

Male

Female

3. Date of Birth
DD

4. Age : Years

MM YYYY

Months

5. (a) Address for correspondence (in capital letters)

Postal code/Zip code
5. (b) Permanent Address (in capital letters)
Postal code/Zip code
6. E-mail id :
7. Contact Telephone No. with STD Code

Phone No.

Mobile No.

8. Nationality
SC ST

9. Category (SC: Scheduled Caste; ST: Scheduled Tribe; PH: Physically Handicapped;
EWS: Economically Weaker Sections; Ex-servicemen; Attach copy of SC/ST/OBC,
PH, EWS, Ex-servicemen, Defense personnel, certificate as applicable for 10% fee
concession)

ExOBC PH EWS Service GEN

men

WORK EXPERIENCE
10. Work Experience (if any)
i) Total Work Experience
ii) List all your work

From

To

years

months and

Total
Complete
d Months
Days

Nam
e the
Organization

days

Designation

Brief Job Profile

ACADEMIC QUALIFICATIONS
11. . Pre-Bachelor's Degree Examination(s):

Std.

th

10 /
High School

th

12 /
Intermediate
/
Senior Secondary

School / Institution

Board/ University

Total
Max.
Marks
Year completed
Marks Obtaine
d

% Marks
Obtaine
d

Class/
Division

12.

Bachelor's Degree Examination(s):

Subject /
Specialization

Degree Obtained

University

College/Institute

Year

Date
To (DD/MM/YYYY)

From
(DD/MM/YYYY)

13.

Marks considered for award of Class/Division in Bachelor's

Degree

CGPA/ % Marks Obtained/ Grade

Post-Graduation Degree/Diploma (if any):

Subject /
Specialization

Degree
Obtained

University

College/Institute
Year
From

To

Subject

(DD/MM/YYYY) (DD/MM/YYYY)

Max.
Marks

Marks
Obtained

Max.
Marks

Marks
% of Marks
Obtained Obtained

% of
Marks
Obtaine
d

Overall percentage of marks obtained

14.

Professional qualification (if any):

Degree
Obtained

Subject /
Specializa
tion

College/Institute

University

Year
From
(DD/MM/YYYY)

To

Subject

(DD/MM/YYYY)

Overall percentage of marks obtained

DECLARATION
I have carefully filled up all the information and agree to abide by the decision of the Institute of Good
Manufacturing Practices India, New Delhi authorities regarding my registration. I certify that the particulars given by me
in this form are true to the best of my knowledge ant and belief.
Date
Place

d4433 400

Signature of Applicant