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	:
Father's Name
Address
Telephone Number

Email Address of the Candidate
Course	:

Educational Qualifications

Examination Passed	Name of the Institute Studied	Group	Year of Passing	% Marks Percentage	Remarks

Additional Qualifications

Fluency in English	:	ExcellentAverageBelow Average
Other Languages Known to Speak / Read / Write
Additional Information you wish to give

How did you get to know about 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.