IIPM School of Management

Mandatory Disclosure

Training & Placement

Jobs at IIPM-SOM

Events & Seminars

Online Application Form

Sl No.

17

Course Applied for *

Personal Details

First Name*

Middle Name

Last Name*

Father's Name

Phone No

Email*

Present Address*

Permanent Address

Gender

Date of Birth*

Age

Place of Birth

Qualification

	School/College	Board/ University	Subjects	Year of passing	Division	Percentage
H S C
Plus 2
Degree/ Diploma

Other Qualification

Qualifying Entrance Test	Score Card	Rank
ORISSA JEE
CAT
MAT
XAT
ATMA

Job Experience

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Extra curricular activity

Achievements/Special position held

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Dated:

Banker's Name:

For Office Use Only (Not to be filled by the Candidate)

Initial Assessment

Interview/Group Discussion

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Admission In Charge

Date

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