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APPLICATION FORM by Ng6zci

VIEWS: 9 PAGES: 3

									                            REGISTRATION FORM

                                        IPNUCLEUS
                            OFF - CAMPUS IP LEARNING
                                                FORM NO:        ____________ (please leave blank)

                                         INSTRUCTIONS

• Incomplete forms will not be considered
• This form is divided into Section A,B and C

  Personal Information                     ..................................... Section A
  Misc Course Related Information          ..................................... Section B
  Payment Information                      ......................................Section C

• Selection to the program is at the discretion of the Institute



Please tick the Capsule of your interest-

       IPNucleusBasic (IPNB)                                                           Please Paste
                                                                                   your recent passport
       IPNucleusAdvanced (IPNA)
                                                                                   size photograph here
       IPNucleusExpert (IPNE)                                                       (3.5 cm X 3.5 cm)




                        SECTION A: PERSONAL DATA
CONTACT INFORMATION (all fields are mandatory)

Name:

Date of Birth:

Address for
correspondence:
Phone Nos.:
(Landline & Mobile
nos.)
Marital Status:

Email id:

Gender:




                                              Page 1 of 3
ACADEMIC RECORD

Institution    Board/University   Year    of    Major        Marks      Examination
                                  passing       Subjects     (%    or   Passed
                                                             CGPA)




WORK EXPERIENCE (Present Job to the First Job)


Total Work Experience, if any ____________________________ months


Organization   Designation   Start date     Brief      Job   Mention     any     specific
                             – End date     Description      experience / achievements

                                                             (please mention if any work
                                                             experience in field of IP)




                                          Page 2 of 3
   SECTION B: MISC. COURSE RELATED INFORMATION

How did you come to know about the program? (Please tick)
                                          Please specify the name of the
                                          Newspaper/Journals etc.
Newspaper Advertisement

Journals/Magazines/Newspaper Articles

Online Search

Mailer From GIIP / Friends

Others (Please Specify)




                SECTION C: PAYMENT INFORMATION
To make payments, kindly make crossed cheque/dd/ pay order in favour of ‘Global Institute of
Intellectual Property Pvt. Ltd.’, payable at New Delhi

Cheque/dd/pay order no. _____________ Dated ___________

Bank / branch _______________________________________

Amount Rs. _______

Cash Received ____________          Location __________



IMPORTANT NOTE:
The Program is GIIP’s independent professional program, aimed at providing training in field of
Intellectual Property Rights. This program is not covered under AICTE. In case of any dispute, it
would have to be got resolved through arbitration under Arbitration and Conciliation Act 1996 by
the sole arbitrator appointed by Global Institute of Intellectual Property at New Delhi. Fee once
deposited is neither refundable nor adjustable under any circumstances.

DECLARATION BY THE CANDIDATE APPLYING FOR THE PROGRAM
I hereby declare that I have read and understood the conditions of eligibility for the program. I
fulfil the minimum eligibility criteria and I have provided necessary information in this regard. In
the event of any information being found incorrect or misleading, my candidature shall be liable to
cancellation by the Institute at any time and I shall not be entitled to refund of any fee paid by me
to the Institute.



____________________________
Signature of the Applicant
Date
Place


                                             Page 3 of 3

								
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