National Institute of Personnel Management, India

PERSONAL DATA

Title1*

First Name*

Last Name*

State*

City*

Pin Code*

Mailing Address *

Check if Mailing Address and Permanent address is same

State*

City*

Pin Code*

Permanent Address *

Date Of Birth*

Chapter (under which you desire Membership)*

Telephone (Office)

Telephone (Resi.)

Mobile No.*

Email Id*

Email address already exists in our database

Fax No.

Photo Upload

Academic Qualifications

Degree*

University *

Year of Passing *

Upload Certificate *

If not a graduate, the last examination passed may be indicated here Yes No

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Present Work Experience

Organization*

Designation*

From*

To whom reporting*

Nature of Business*

No of persons employed in the establishment

Address of Organization*

Nature of duties & responsibilities (in reasonable details)*

Are you holding a managerial or administrative position? Yes No

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Past Work Experience

Organization

Designation

Duration From

Duration To

Nature of Business

No of persons employed in the establishment

Address of Organization

Nature of duties & responsibilities (in reasonable details)

To whom used to report

Document/ Proof of Experience Certificate

Were you holding a managerial or administrative position? Yes No

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Other Information

Were you a NIPM Member earlier Yes No

Are you a Member of any other Institute/Organization Yes No

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Reference

Reference #1

Member Name

Membership No

Email ID

Mobile No

Address

Reference #2

Member Name

Membership No

Email ID

Mobile No

Address

Payment

Method*

Membership Type*

Entrance Fee

Subscription

Life Member Fee

Bank Charge (%)

CGST (%)

Finance Year

SGST (%)

IGST (%)

Bank Name

Branch Name

Date*

Cheque/ Draft No*

Total Amount

Grand Total

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Declaration

I certify that the statements made above are true. If admitted. i shall accept the decision of tha National Council of the Institute regarding the category of membership and shall abide by the regulations of the Institute and the Rules framed thereunder from time to time as also the Code of Ethics of the Institute.