I Have Blank Pan Card Application Form by zat13158


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									                                               APPLICATION FORM
                                                                                                 Please paste your
                                                                                                recent passport size
Student ID No. (Please leave blank)                                                              colour photograph
                                                                                                     in this box.

                                                                                                 DO NOT STAPLE

Name of course applied for:

                             (To be typed or handwritten in blue or black ink)

                                (As you would like on your Certificate / Mark sheet)

Gender:___________ Date of Birth:_________________


Address: ________________________________________________________________________________


City:________________________ State:____________________________ Pin:_______________________
Mobile / Telephone: ______________________________________________________________________
                                      (Important course related information will be sent by SMS)

Email (compulsory):______________________________________________________________________
                                         (This is our primary method of contacting you. Please fill in clearly)

                                                       Fee Details

 Demand Draft no: _________________________ Amount: ________________ Dated: ______________________

 Bank Name: _____________________________________________________________________________________

 In favour of “Institute of Intellectual Property Research & Development”, payable New Delhi
Educational Qualifications:

Name of Degree/ Exam       Year of passing           University/ Board          % of marks secured

If you have previously been admitted to any IIPRD Seminar/Workshop/Course, please mention
the details for the same

Please enclose self-signed photocopies of the following documents:

1. Proof of identity: (Tick any one)
    Driving licence           Passport                  PAN Card                   College ID card

2. Proof of educational qualification (any one)
    Mark sheet              Degree                      Diploma                    Other (pl specify)

DO NOT send any original documents. Please submit only self signed photocopies.

       Please send the application form and                        Need help? Contact us
                 demand draft to:
                                                                Tel: +91-120-2342010
     Admissions Office,                                         Tel: +91-120-3104849
     Institute of Intellectual Property Research &
     Development,                                               Fax: +91-120-2342011
     IFAIA Center, S/20-22
     Greater Noida Shopping Plaza, Kasna Road                   Email: iiprd@iiprd.com
     Plot No. 7/2, UPSIDC- Site IV                              URL: www.iiprd.com
     Greater Noida - 201308

By my signature below, I certify that to the best of my knowledge and belief, the information provided
in this application form is true and complete.

Signature of the applicant                                                 Date:

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