CAF No :

INSTRUCTIONS FOR FILLING APPLICATION FORM

July - September 2012 Admissions

All applicants need to complete the Common Application Form (CAF) as the first step in admission process. Selection is on the basis of experience, educational
background, Program Aptitude Test (PAT) as applicable, and the application material.

• Fill the CAF in CAPITAL LETTERS ONLY in your own handwriting. Do not overwrite
• All supporting documents (including Photocopies of Originals) have to be legible and must be SELF-ATTESTED
• Applicant should paste one recent, coloured passport size photograph. The photograph should not be stapled or clipped. There should be no overwriting on the
photograph. For online application, the softcopy of the photo can be uploaded. Please mention your complete name on the back of the photograph
• Each box, wherever provided, should contain only one character (alphabet / number / punctuation sign) leaving a box blank after each word
• For descriptive notes, write in capitals and point wise. Ensure it is legible and readable clearly

Read the below given instructions given below carefully before filling the application form.
INSTRUCTIONS

PART A
PERSONAL DETAILS
1 Applicant Name In all communications and certificate your First Name followed by Last Name will be printed. Hence, ensure your name is
mentioned appropriately as required
Salutation/Title Tick the appropriate box – Mr. / Mrs. / Ms. / Dr.
First name Specify your first name
Last name Specify your middle name and last name including your surname

2 Gender Tick the appropriate box

3 Date of Birth (DD/MM/YYYY) Your date of birth as per official records (10th standard certificate or Date of Birth certificate or any other document to
be enclosed). Your Date of Birth (DOB) will be your password to access your online application form and results

4 Nationality Specify your nationality

5 Mother Tongue Specify your mother tongue

6 Address for Correspondence Give your complete postal address, where you would like to receive all regular communications
Landline Phone Number Specify the Landline Phone No. with STD Code in the boxes provided separately

Mobile Number Mention your 10 digit Mobile Number. All Important communication / messages will be sent to your Mobile Number.
Mobile No. is mandatory

7 Primary E-mail ID Give the most regularly used E-mail ID which we can use to communicate with you. This will also serve as your Login ID
for accessing your application and results. E-mail will be the primary mode of communication from NIIT Imperia and the
Institute. It is mandatory to provide the E-mail Id. For re-validation, reenter the Primary E-mail ID if submitting online
application

8 Alternate E-mail ID This is Optional. Alternate E-mail ID will be used only if mails sent to your primary E-mail ID is not working

9 Total Annual Family Income Tick the appropriate box. The values mentioned are in Rupees Lakhs/ Year

ACADEMIC DETAILS
10 Examination Details
10a 10+2 Mention the group like MPC (Maths Physics Chemistry), BiPC (Biology Physics Chemistry), CEC (Commerce) etc., 3 year
Area Polytechnic Diploma after completion of 10th should be mentioned here

Discipline/Subjects Mention main subjects studied Science/Arts/Commerce/Computers etc.

Year Year of completion of the said Exam

School/College Name of the School or College where you have studied

Board/University Name of the Board or University under which the examination was given

%Marks Enter the % marks for the overall program. In case of CGPA system, convert the score into equivalent %. (E.g. 7.28 on 10
will become 72.8%; 3.1 on 4 will become 77.5%)

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10b Graduation Only Indian University / Institute UGC / AICTE / DEC / AIU recognised Degree/Diploma (10+2+3 only) is considered as valid.
Foreign university degree is not valid

Area Mention BA / BSc / BCom / BE / BTech / Law/ MBBS/ BBA/ BEd / Others

Discipline/Subjects Mention the subject area of your degree or major subject area. For example, Botany, English Literature, Commerce,
Mathematics, Mechanical, Civil, Electrical, Hotel Management, Marine Engg. etc. If you have done 3 year Engineering
after doing diploma, clearly mention it as 3 yr Engg.

Year Year of passing the Degree program

School/College Name of the College where you have studied

Board/University Name of the Board or University under which the examination was certified

%Marks Enter the aggregate % marks for the overall program. Different universities adopt different methods of % declaration.
However, the % marks is calculated basis summation of marks scored in all subjects across the total duration of the
graduation divided by summation of maximum marks for each of the examination. In case of CGPA system, convert the
score into equivalent %. (E.g. 7.28 on 10 will become 72.8%; 3.1 on 4 will become 77.5%). All years of mark sheets to be
necessarily enclosed with the application form.

Post Graduation Mention MA/ MCom/ MSc / ME / MTech / LLB / CA/ ICWA / MS / MD / MBA / MCA / PGDBM /Others
10c
Area Mention the subject area of your PG or major subject area. For example, Botany, English Literature, Commerce,
Discipline/Subjects Mathematics, Mechanical, Civil, Management, Hotel Management, Marine Engg., Computer Science, Law, Cost
Accounting etc.

Year Year of passing the Post Graduation program

School/College Name of the College where you have studied

Board/University Name of the Board or University under which the examination was certified

Marks/CGPA Enter the aggregate % marks for the overall program. Different universities adopt different methods of % declaration.
However, the % marks is calculated on basis summation of marks scored in all subjects across the total duration of the
graduation divided by summation of maximum marks for each of the examination. In case of CGPA system, convert the
score into equivalent %. (E.g. 7.28 on 10 will become 72.8%; 3.1 on 4 will become 77.5%). All years of mark sheets to be
necessarily enclosed with the application form

10d Others Specify any other academic qualification in addition to the ones mentioned above or which does not
qualify in the above list
EMPLOYMENT DETAILS
11 Occupation Tick the appropriate box
12 Functional Area Specify your primary functional area of work. For example, General Management, Sales & Marketing,
Software Development, Finance, Accounting, Commercial, Human Resources, etc.

13 Total No. of Years Experience Specify the total years of paid full-time employment after you completed Graduation. Should have supporting document
proofs. For the eligibility requirement, the work experience is calculated as per the following:

Program Experience calculated as on

Senior Management Program (SMP) 1st August 2012
Executive Program in Applied Finance (EPAF) 1st August 2012
Executive Program in Managing Business Decisions: A Quantitative Approach (EPMBD) 1st August 2012
Executive Program in Sales Management (EPSM) 1st September 2012
Post Graduate Diploma in International Business Strategy (PGDIBS) 1st October 2012
Executive Post Graduate Program in Management (EPGP) 1st September 2012

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14 Work Experience Only those with full-time job experience undertaken in progress after completing graduation and through a valid
appointment order of a statutory company with proper terms and conditions including salary will be the qualifying work
experience. For all the experience mentioned, you need to provide documentary proofs in the form of Experience
certificate issued at the time of resignation (clearly stating the DOJ and DOR), or Appointment letter copy and
corresponding relieving letter.

As proof of current employment status, letter from the HR dated current month or the current month pay-slip is required.
Any experience mentioned without necessary proof will not be considered for calculating the experience. For those with
own Business / Professionals, need to produce the Memorandum of Article, and the latest IT returns along with the
certificate from CA certifying the company is operational. The decision of selection / scrutiny committee in evaluating the
professional experience is binding

Begin with your Current Organisation followed by the previous company details.
Organisation
This is mandatory. Specify your date of joining. It has to match with the experience letter attached.
From (mm/yy) This is mandatory. Specify your date of relieving. It has to match with the experience letter attached. For the current job
To (mm/yy) specify the ‘to date’ as ‘Till Date’

Total experience in number of months to be entered

Total Experience (in months)
Enter the last / current designation in your company
Designation at end
Specify your total pay in rupees thousand per annum
Annual Salary at end
Specify your nature of work in your job
Nature of responsibilities

15 Sponsorship Are you an Industry Sponsored Candidate? Tick the appropriate box. Attach copy of sponsoring company’s letter signed by
the Corporate HR of the company
APPLICATION DETAILS

16 Preferred Study Centre Write your preferred study centre name and code given in brackets where you wish to pursue the program. Only one
study centre can be selected. Study Centre with CCR is applicable only for the respective corporate employees

Ahmedabad (SC01); Bengaluru - Jayanagar (SC02); Chennai - Mylapore (SC06); Delhi-Nehru Place (SC07); Gurgaon (SC08);
Hyderabad - Basheerbagh(SC09); Kolkata (SC11); Mumbai - BKC (SC13); Pune (SC18); Bhopal (SC03); Bhubaneswar(SC04);
Chandigarh (SC05); Jamshedpur (SC10); Lucknow (SC12); Mysore (SC14); Nagpur (SC15); Nasik (SC16); Patna (SC17);
Coimbatore (SC18); Jaipur (SC19); Mumbai - Thane(SC20); Delhi - Dwarka (SC21); Noida (SC22); Mumbai – Borivali (SC23);
Mumbai – Andheri East (SC24); Mumbai – Vashi (SC25); Pune – Kharadi (SC26); Chennai – Cochin (SC27); Delhi – Rajendra
Place (SC28); Indore (SC29); Chennai – Sholingnallur (SC30); Mumbai – Andheri West (SC31); Bengaluru – Bommanahalli
(SC32); Yelahanka (SC33); Hyderabad – Hubsiguda (SC34)
17 Program Preference Please specify the name and code given in bracket of the program you are applying for
Program
Senior Management Program (SMP) – IIM Calcutta
Executive Program in Applied Finance (EPAF) – IIM Calcutta
Executive Program in Managing Business Decisions: A Quantitative Approach (EPMBD) – IIM Calcutta
Executive Program in Sales Management (EPSM) – IMT Ghaziabad
Post Graduate Diploma in International Business Strategy (PGDIBS) – IIFT New Delhi
Executive Post Graduate Program in Management (EPGP) – IMT Ghaziabad

18 PAT Centre Write your preferred test venue name and code in the space provided where you wish to appear for the exam. Choose
from the list of centres mentioned below. The exam will be conducted at NIIT Imperia centres only. The PAT centre can
be different from the choice of your study centre
Ahmedabad (PC01); Bangalore (PC02); Chennai (PC06); Delhi-Nehru Place (PC07); Hyderabad (PC08); Kolkata (PC10);
Mumbai (PC12); Pune (PC17); Bhopal (PC03); Bhubaneswar (PC04); Chandigarh (PC05); Jamshedpur (PC09); Lucknow
(PC11); Mysore (PC13); Nagpur (PC14); Nasik (PC15); Patna (PC16); Jaipur (PC18); Coimbatore (PC19); Mumbai -
Thane(PC20); Delhi - Dwarka (PC21); Noida (PC22); Mumbai – Borivali (PC23); Mumbai – Andheri East (SC24); Mumbai –
Vashi (SC25)
19 PAT Date Please specify your preferred date for taking Program Aptitude Test (PAT). The PAT is scheduled from 12:30 p.m. to 2:00
p.m. on the available PAT dates
SMP: 01/07/2012, 22/07/2012, 05/08/2012, 26/08/2012
EPAF: 22/07/2012, 05/08/2012, 02/09/2012, 23/09/2012
EPMBD: 01/07/2012, 29/07/2012, 02/09/2012
EPSM: NA
PGDIBS: NA
EPGP: 26/08/2012, 16/09/2012, 12/08/2012
NIIT Imperia at its discretion can allot a different PAT date if there are no seats available on the selected PAT date.

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 20 Application Fee Application fee is `1,124/-
Application fee (`1,124/-) can be paid in Cash / Cheque / Demand Draft / Online payment / EFT
An Initial Amount towards the registration of the program is payable at the time of application submission through
Cash/Cheque/DD only.

Initial payment will not be refunded in case of any/all of the following conditions:
a. The application is found to be incomplete or inaccurate at any stage of scrutiny (Appearing in PAT does
not confirm application acceptance/clearance of scrutiny)
b. The applicant is offered a seat for the program and does not join before the date mentioned in the
offer letter.
It is the responsibility of the applicant to ensure that the application is complete in all respects.
All fee are non-refundable, however, if the batch start for a program is delayed by more than 3 months, the applicant can
apply for a refund.
Initial payment will be refunded completely if the applicant is not selected for the program by the institute. This does not
include the application amount of `1,124/-.
For the exact amount & details on initial payment, please visit www.niitimperia.com
Cheque / Demand Draft to be drawn in favour of “NIIT Ltd Imperia Collection A/c”. Only local cheque and at par cheque
will be accepted. Kindly write your Name, Address & Phone Number on the reverse side of the Cheque / Demand Draft.
EFT payment to be made to the following account
A/c Name: NIIT Ltd Imperia Collection A/c
A/c No: 0007 0501 8480
Branch: Connaught Place, New Delhi
Customer ID: 512814714
Write your name in the remarks column while making the EFT payment. In the application form, mention the EFT
transaction number, date of transaction and the bank details clearly
The application form will be processed only after the payment is realised/recieved by NIIT

21 Declaration Read the declaration carefully and sign the same with the date. For those who are filling online application form, need
to take a printout of the filled form and sign the form and send it along with the supporting documents

ANNEXURE I
Statement of Purpose Please give a detailed write-up in the space provided on why you wish to undertake this program. Typically, your answer
should include your reasons for doing this program, how the program relates to your background and experience so far,
what you wish to achieve after completing this program, etc. Make it as point wise as possible and write in capital
letters clearly legible

PART B
1 Name Same as mentioned in Part A of the form
2 Permanent Address If permanent address is not same as the correspondence / mailing address mentioned in part A. It will be used as
mailing address only in case of non-delivery of any mail at the correspondence address
3 Marital Status Select ‘single’ if you are unmarried, or one of the other options provided
Spouse Name If married, specify your spouse name
Designation Specify your spouse occupation – Designation
Organisation Specify your spouse occupation – Organisation
4 Academic Achievements Mention any awards / achievement / highlights / recognition during your academic career
5 Professional Achievements Mention any awards / achievement / highlights / recognition during your professional experience
6 Training programs Mention the latest Management Development Programs you have undergone
Form Submission:
• The completed Common Application Form (CAF) Part A, Annexure I, SOP and Part B, accompanied by the requisite Application Fees, Checklist, and copies of all
the necessary supporting proofs must be submitted using any of the following modes:
• The application form can be filled online at www.niitimperia.com or can be downloaded and filled manually
• On submission of online form, a CAF number will be displayed by the system. Note down the CAF No. for future reference, write the CAF number on
all the supporting documents & send the documents by post to the nearest NIIT Imperia Centre or central admission cell. Don’t forget to write your
CAF No. on the documents
• Filled in form can be submitted in person at nearest NIIT Imperia centre on/or before the last date of application submission
• The documents can be posted to the “NIIT Imperia Admission Cell; 1st Floor - Minerva Building, Balaji Estate, Sudarshan Munjal Marg, Kalkaji, New
Delhi - 110019” so as to reach on /or before the last date of application submission
• Forms received after the last date will be rejected and no communication will be entertained. NIIT Imperia or the Institute will not be responsible
for any delay due to postal or courier service
• Arrange the Application Form and the supporting documents in the order mentioned in the Checklist, with the Checklist on the Top. Incomplete
application and supporting documents or False Information in the Application will result in rejection of the Application. No correspondence in this
connection will be made and no fee will be refunded.
• All fee are non-refundable, however, if the batch start for a program is delayed by more than 3 months, the applicant can apply for a refund.
• All documents should be clearly legible

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Important Dates:

Program Early Bird Last Date* Last date of application (Non- Early Bird) PAT date

SMP July 20, 2012 August 23, 2012 July 01 & 22 and Aug 5 & 26
EPAF August 01, 2012 September 21, 2012 July 22, Aug 05, and Sept 2 & 23

EPMBD July 25, 2012 August 28, 2012 July 01, 29 & Sept 2

PGDIBS Sept 05, 2012 October 22, 2012 NA

EPSM August 31, 2012 November 09, 2012 NA

EPGP August 24, 2012 September 14, 2012 August 12, 26 & Sept 16

For details on Early Bird Offer, please contact your nearest NIIT Imperia Study Centre.

Application Foreclosure Clause:

Due to limited seats,

1. Applications acceptance can be fore closed anytime (at all or select locations) after early bird last dates corresponding to each program
2. Applicants are advised to apply as early as possible to avoid early closure of application acceptance.

General Instructions:
• NIIT Imperia centres are only collection points for application and acceptance of form does not certify the completeness / correctness of the application
form and/or the supporting documents
• It is the responsibility of the applicant to ensure that they satisfy the eligibility requirements for the program(s) applied for
• All fees once paid are non refundable
• For selected candidates, Registration formalities including payment of fees have to be completed within the last date mentioned in the offer letter. NIIT
Imperia or the Institute will not be responsible for any delay in Bank loan disbursement or releasing the payment by the sponsoring company
• Program fee mentioned in the Program prospectus is the net fee which does not include the campus module fee. Also, the campus module fee does not
include travel & boarding expenses. NIIT Imperia or the Institute will not be responsible for any reimbursement of travel expenses due to change in
campus module dates
• All Original Certificates and supporting documents need to be produced during the campus visit or at any time for verification by the Institute / NIIT
Imperia. Non-availability of original documents may lead to disqualification of the admission
• NIIT Imperia and the Institute at their discretion may change the program dates without prior notice, and will not be held liable for the same
• Retain this instructions sheet for your ready reference
• Visit http://www.niitimperia.com for the latest updates and additional information

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