NATIONAL INSTITUTE OF LABOUR

EDUCATION AND MANAGEMENT (NILEM)

59, Second Street, Parameswari Nagar, Adyar,
Chennai – 600 020. INDIA.
E-mail : info@nilem.com, nilem@rediffmail.com, AFFIX YOUR
PHOTOGRAPH
Web site: www.nilem.com, HERE
Phone: 91-44–42115296, 24911443

APPLICATION FORM – 6 MONTHS

For Office use

Regn. Number :

FILL THE APPLICATION NEATLY IN CAPITAL LETTERS

1. Name of the Diploma Course :
you wish to join

2. Name of the Applicant :

3. Address for Correspondence :

(Contact Phone No., Mail ID if any)

4. Date of Birth : Age : Yrs.

5. Nationality : 6. Sex :

7. Educational Qualification :

8. Employment Record (if any)

Designation :
Office Name, Address and Phone No. :
Period of Employment :

9. Details about payment of Fee

Name of the Bank : D.D. Number :
Date : Amount :

10. I declare that the particulars given above are correct and that I will, if admitted, abide by the rules &
regulations of NILEM.

11. I am aware of the fact that the course I desire to join is NOT recognised by AICTE
.
Date :

Place : Signature of the Applicant

ENCLOSURE :
1. Xerox copies of (a) Date of Birth (b) Educational Qualification.
2. Demand Draft for Rs.2,500/- (in favour of NILEM payable at CHENNAI)
Please send the Enrolment Form, Demand Draft & Enclosures to NATIONAL INSTITUTE OF
LABOUR EDUCATION AND MANAGEMENT, 59, SECOND STREET, PARAMESWARI NAGAR,
ADYAR, CHENNAI – 600 020, INDIA. Phone: 91-44 –42115296. E-mail : nilem@rediffmail.com