IIRM INSTITUTE OF INSURANCE AND RISK MANAGEMENT

(A Joint Initiative of IRDAI and Govt of Telangana)
Financial District, Nanakramguda, Gachibowli, Hyderabad-500 032
Ph No: +91 40 23000005, Mobile: +91 8106360044. Toll Free: 1800 425 2041. Email: admissions@iirmworld.org.in, Website: www.iirmworld.org.in

PGDM APPLICATION FORM

Note: In case of any technical issue while filling application form, you can contact 99486 07128

Name of the Student Mr/Ms: *

Father Name: *

Date of Birth: *

Gender: * Male Female

Email ID: *

Mother Name: *

Communication Address: *

Permanent Address: *

City: *

State: *

Country: *

Zip/Pin: *

Land Line:

Mobile: *

photo size < 500 KB

Course Applying for: *

Courses	Stream
PGDM / Masters Program	Test Score To be appearing later Alumni
Selection of Specializations:
Students can opt for one specialization from each of the following:
Specialization 1
Specialization 2

Educational Certificates starting with highest qualification: *

Level	Qualification(s)	Year of Passing	Board/University	Aggregate Percentage
Graduation
Inter / +2 equivalent
SSC or equivalent

Academic Honours / Extracurricular Activities:

Work Experience (if any):

Company	From	To	Designation & Work Description

Declaration of the Applicant *

I declare that the information furnished in this application is true to the best of my knowledge. At the time of interview for admission I will produce documentary evidence of my qualification and experience.

Proceed to pay Rs.500 towards registration fee.