NATIONAL INSTITUTE OF BANK MANAGEMENT

NIBM Post Office, Kondhwe Khurd, Pune 411 048

Tel : 020-26716000 (EPABX), Fax : 020-26834478,
e-mail : learning@nibmindia.org, Website : www.nibmindia.org
APPLICATION FORM
ONLINE CERTIFICATION PROGRAMME

Personal information:
First Name (Mr/Ms.)
Middle Name
Last Name
Date of birth
DD MM YYYY
(dd/mm/yyyy):
Please tick mark: Male ( ) Female ( ) Other ( )

Mailing Address:
House No./Area/
Locality/Street/
City
State
Pin Code
STD Code & Tel. No.
E-mail
Mobile
Alternate E-mail

Last academic qualification:

Degree
University

Current employment details:

Organization
Employee ID No.

1
Please tick to select course (ONLY ONE):
Risk Credit Treasury Accounts and Retail Credit
Management Management Management Audit Management
( ) ( ) ( ) ( ) ( )

Details of NEFT/Demand Draft:

Remitter ’s Name:
UTR No.
Amount (Rs)
Date of Remittance
(Please attach scan copy of the NEFT).

Name of the Bank

DD No.
DD Date

Declaration:
All entries made in this application form are true to the best of my knowledge and belief. I am willing
to produce original certificates in support thereof if asked to do so at any stage. Admission can be
cancelled at any stage, if any information given is found to be incorrect.
Place:

Date: Signature

2
 Instructions for Applying to
ONLINE CERTIFICATION PROGRAMME

1. Application form to be duly filled in and mailed to the Institute

2. Admission to be made for any single course at any given time
3. Course comprises of Online learning with Virtual Classroom
4. Proof of employment in any bank or financial institution to be provided
5. Total fee to be paid with application

Fees may preferably be transferred by RTGS/NEFT/ECS to our A/c No. 20002400021 with Bank of
Maharashtra, NIBM Branch, Pune (IFSC Code MAHB0001124). NIBM PAN No. AAATN0040P and ST
No. AAATN0040PST001.

Applications to be sent to:

Coordinator - Online Certification Courses
e-mail: learning@nibmindia.org