Chanderprabhu Jain Institute of Management & Technology

Courses

Course opted for

Part time Regular

Year/Semester

SemesterYear

Name *

Father's Name *

Date of Birth *

Present Address *

Phone No.*

Mobile No.*

Email Id

Correspondence Address *

Pin Code

Category *

Gender

Qualifications:

Exam	Year of Passing	Board / University	%	Subjects
Secondary
Sr.Secondary
Graduation
P.G.
Others

Fee Details:

Course Fee :

Please contact with institute

Amount Deposited

/-Rs. Bank Date

Mode of Payment

CashChequeDD

Cheque/DD/UTR No.

Declaration

I declare that all the information furnished above is correct to the best of my knowledge and belief. I fulfill the eligibility criterion for the admission to the course for which I am seeking admission. I shall be responsible if I do not observe the rules and do not fulfill the academic qualifications and other requirements for admission laid down by University, and the CPJIMT will not be responsible for any consequences arising there from.

I agree the terms & condition of CPJIMT.