Form No.

INDIAN INSTITUTE OF MATERIALS MANAGEMENT

Stamp size
Course: _____________________________________________________________ photograph
to be attested
dully signed
Roll No. :___________________________________________________________ across
(For IIMM use)

CHOICE OF EXAM CENTRE :

(Select from the prospectus)
1. Name of the applicant (in BLOCK LETTERS, as in 10 +2 mark sheet/UG/PG/PG Diploma certificate)
Surname Name fathers name

2. Fathers /Husbands Name

Surname Name fathers /Husbands name

3. Mother s Name

4. Date of Birth Day Month Year

5. Sex: Male Female 6. Nationality

Indian Others
7. Category - General SC ST PBC PH

8. Students E-mail ID: ___________________________________________________________________

9. Address to which communication is to be sent: (Name not to be mentioned) (in BLOCK LETTERS)
Line 1
Line 2
Line 3
Line 4

Pin code Phone :

STD Code
10. Office Address: Mobile:
Line 1
Line 2
Line 3
Line 4

Pin code Phone :

STD Code
11 Educational Qualification (Attested copies must be enclosed)
Qualification Name of course Year of passing % Marks University/Institute
P.G. Degree/P.G.
Diploma
Degree
Diploma
10 +2

11. Experience Profile (please mention from current job title) (Attested copies must be enclosed)
Organization Job Title Period
From TO

12. How did you get to know about IIMM COURSES?

Newspaper Website Friends Others (Pl. Specify)

13. Elective paper (for PGDMM Course only)

Declaration
I declare that all the information submitted in this application form is correct and complete. I
acknowledge that the IIMM reserves the right to vary or reverse any decision regarding admission on the
basis of incorrect or incomplete information provided by me.
I declare further that I had read & understood all contents of this application form & information
Brochure and that I am bound by all their contents for all purpose.
I have no objection if I receive any sms or email from IIMM. I hereby declare that in case of any
grievances, I shall approach the student Grievance Committee for appeal and then their decision will be
final.

Date : Signature of the Candidate

For IIMM Use

Aptitude Test Details (only for PGDMM course)

Max. Marks Min. Marks Marks obtd. Admitted Yes No.

Aptitude Test 100 50
Viva Voce 100 50 Signature of Course Coordinator

This form, together with supporting documents should be sent to:

The Course Coordinator of the IIMM Branch for admission.
Check List: (put tick mark)
1. Statement of Marks (Xerox Attested)
2. Degree Certificate (Xerox Attested)
3. Provisional certificate
4. Work experience Certificate (Xerox Attested )
5. Filled-in Identity Card duly signed with photograph
pasted
6. DD for Rs.400/- towards CAT fee
(for PGDMM course only)

For details contact:

Assistant Registrar
INDIAN INSTITUTE OF MATERIALS MANAGEMENT
NHQ EDUCATION WING
102, & 104 Institutional Area, Sector 15, CBD Belapur, Navi Mumbai - 400 614
Ph. : 91-22- 27571022 , Telefax : 91-22-27565741
E-mail : iimmedu@iimm.co.in

Note:
Candidates should enclose the D.D. of Rs 700/- in favour of IIMM NHQ Collection A/c
payable in Mumbai while applying.

OR

Payment can be sent by

NEFT:
A/c name : IIMM NHQ Collection A/c

Saving Bank A/c no. : ICICI bank a/c no. 015101027881

Branch : Vashi

IFSC code: ICIC 0000151

If you are transferring the funds kindly send cyber shot or screen shot of your transaction
by sending a separate attachment.(which must bear your bank transaction Number) by
email to iimmedu@iimm.co.in along with scan copy of the application form and
certificates as mentioned in above column.

(Hard copy of prospectus with application form will be sent by post to him/her on
receipt of the D.D/ NEFT payment)