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Online Registration for Admission in IIMSHE Comunity College
Bhopal (M.P.) India

 

Please deposit an amount of INR 1100/- only as registration and form fee to our following bank account.

 

Bank Name : Soutn Indian Bank

Branch Name : Indrapuri, Madhya Pradesh, India Bhopal

Account Number : 0443053000000855

Account Name : Institute of Industrial Management for Safety, Health & Environment

IFSC Code : SIBL0000443

SWIFT Code : SOININ55

 

After deposit please inform us through mail at our email ID : iimshe.safety@gmail.com with your deposit detail (Bank transaction ID, date of deposit etc.), online generated registration ID, name and course applied for.

 

Note: * Marked fields are mandatory

 

Course Applied for :

Gender :

*Name in Full :

Specify Category :

* Father's / Spouse Name :

Date Of Birth :

DD

MM

YY

Nationality :

Domicile State :

* Address for Correspondence :
(In block letters)

* Permanent Address :

Telephone (With STD code) :

STD Code

 

 

Tel No.

 

 

* Mobile :

* E-Mail Address :

 

Educational Qualification :

S.No.

Examination Passed

University / Board

Year of Passing/Award

Division/Grade

% of Marks#

Subject Taken

1.

Post Graduation

2.

Graduation

3.

*HSSC(XII)

4.

*High School/HSC (X)

# Percent conversion of grade should be specified and the proof of conversion factor should be shown at the time of interview

 

References (Minimum Two) Name, Designation, Institution Address, Tel./Mob. No. and Email id of Referees:

* Reference (I) :

* Reference (II) :

Any other relevant information :

Declaration:

 

I affirm that the information given in this application is true and correct. I also fully understand that if at any stage it is discovered that an attempt has been made by me to willfully conceal or misrepresent the facts, my application for admission may be summarily rejected.

 
   

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