Online Admissions IIHMCA Online Application Form ( Affix latest Passport size Colour Photograph) Instructions Read the application form carefully before you fill it. Please use ( √ ) tick mark in appropriate boxes wherever required. The application form will be attended only if all the required information is included. Please re-check form to ensure you have not left any data un-filled. All Information you provide will only be used by our Admission Department and will remain strictly confidential. Personal Details Name of the Student : Date of Birth and Age : Blood Group Fathers Name Mothers Name Address for Correspondence Telephone Number Permanent Address Telephone Number Email Address of the Candidate Aadhar Number of the Candidate Course : - Select -(BCT&CA)(BHM&CT)(F.P.P) Educational Qualifications Examination Passed Name of the Institute Studied Group Year of Passing % Marks Percentage Remarks Additional Qualifications Fluency in English : ExcellenceAverageBelow Average Other Languages Known to Speak / Read / Write Work Experience Organisation Designation Years of Service Nature of Work Family BAckground Relation Ship Name Occupatoin & Designation Contact Phone Number Father Mother Brother / Sister Brother / Sister Brother / Sister Extra Curricular Activities and Certificates / Prizes Won Additional Information you wish to give How did you get to know about IIHMCA? : - Select -IIHMCA WebsiteNewspaperHoardingsAlumniWeb PortalsCoaching InstituteEducational ConsultantsFriendsFacebookSeminar attendedPresent Student of IIHMCA *Specify : Declaration by Applicant: I declare that all information in my application is complete, factually correct and honestly presented. I have read the rules and regulations mentioned in the admission brochure and will adhere to the same. I also understand that fees once paid will not be refunded under any circumstances. Date : Place : *After you submit the form you will be prompted to make the payment.