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Application Admission Form
 
     
 
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Write an application with your name and address & post it with Rs. 500/- DD/P.O to have an application form posted to you.
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ONLINE ADMISSION APPLICATION FORM  
* indicates compulsary fields  
   
Name of Course Applied *
   
Admission for the year* 20
Student Name* First Name:
Middle Name:
Last Name:
Date of Birth*
Sex*
Male Female
   
Name of Father / Guardian*
Occupation of Father / Guardian*
   
Permanent Address  
Address*
City*
State*
County*
PIN / Zip*
Phone*
Fax
Email
   
Correspondence Address Same as above
Address*
City*
State*
County*
PIN / Zip*
Phone*
Fax
Email
   
Educational Qualification  
Education* (i.e. 10th)
Name of Board / University*
Subject(s)*
Total Percentage / Grade *
Year of Passing*
   
Education (i.e. 10 + 2)
Name of Board / University
Subject(s)
Total Percentage / Grade
Year of Passing
   
Education (i.e. B.A., B.Com...)
Name of Board / University
Subject(s)
Total Percentage / Grade
Year of Passing
   
Hostel Facility Required*
Yes No
From where did u heard about
APIM?*

e.g. Newspaper, Friends, Family, T.V. Chennal etc.
Family Details*  
  Father Mother
Name
Age
Occupation
Total Household Income / Year Rs.
No. of Brother / Sister Earning
No. of Brother / Sister Studying
   
DECLARATION  
1. I Mr./Mrs.*
  Son Of / Daughter Of*
2. I assuare that I will not indulge in any activity that would tarnish the image of the Institution.
3. I am aware that the management of APIM has every right to suspend / dismiss me from the institute or even debar in cas I breach the code of conduct.
4. I am aware that the fee once paid will not be refunded under any circumstances.
5. I am aware that my admission is subject to the approval of APIM
6. All information provided above are true and verifiable to my knowledge.
   
 
I AGREE TO THE TERMS
 
PAYMENT DETAILS
Please tick the mode of payment* DD MO
Amount*
Date*
Bank Name / Post Office *
Branch*
   
 
 
 
 
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