International Institute of Development Management Technology

Nomination Form

1.

Name of the Programme:......................................................

2.

Name (Nominee/Self):..........................................................

3.

Father's Name:.....................................................................

4.

Nationality:.........................

5.

Sex:..................

6.	Date of Birth:	.................................	Place of Birth:	...............................
7.	Passport No:*	.................................	Place of Issue:	...............................
8.	Date of Issue	.................................	Date of Expiry	...............................

9.	Permanent Address:..................................................................................
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10.	Tel:	...............................	Fax:	.............................	E-mail:	..........................
11.	Occupation & Place of Work Address:......................................................,
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12.	Tel:	...............................	Fax:	.............................	E-mail:	..........................

13.

Educational Background:...........................................................................

14.

Experience:................................................................................................

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15

Sponsor (Employee Self):.........................................................................

16.

DD/Cheque No.

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Dated:

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[In words:.......................................................................................... only]

In favour of ASEED A/C IDMAT (for Indian Delegates) & ASEED A/C INTERNATIONAL
(for International Delegates) payable at Delhi to be sent with the nomination form.

Date: ....................

Signature

*Compulsory information for International Delegates.

Print this Nomination Form
AND

Send your Nominations and queries to:

Programme Manager, IDMAT International Programmes
C-8/8007,Vasant Kunj, New Delhi-110070
Tel: 26130780,Tel/Fax: 26130242,26130635,
Website:www.aidmat.com
E-mail: training@aidmat.com