APPLICATION FEE : Rs.300/-

Account holder name: Director, ICM Kannur, Current A/c No.32402034436, IFS code: SBIN0000822, State Bank of India, Kannur Branch.

HIGHER DIPLOMA IN COOPERATIVE MANAGEMENT (HDCM) (35th Session) 2023-24
APPLICATION FORM FOR ADMISSION (All fields are compulsory) Before filling the application form, please make online payment of application fee and collect the UTR No. /Transaction ID 1 Name of the Candidate (In BLOCK letter) * 2 Male/Female * Male Female 3 Date of Birth * Age as on 01-01-2023 4 Name of Father / Guardian * 5 Permanent address : * 6 Address for Communication : * Pin Code * District * Phone * 7 WhatsApp Mobile No.(Compulsory) * 8 Email ID (Admission Memo will be sent by email only) * 9 Religion * Community * (If belongs to SC/ST, Community Certificate to be attached) Upload Image of Max size 100KB * ( File should be an image file ie jpg, jpeg, png ) SC ST Others 10 Are you an Institutional Candidate? * (If yes, attach copy of Board Resolution/Employer’s consent letter) Upload Image of Max size 100KB * ( File should be an image file ie jpg, jpeg, png ) Yes No 11 Upload a Passport Size Photo (Max size 100KB) * ( File should be an image file ie jpg, jpeg, png )
12. Details of Degree Examination passed Degree * Main Subject * University /Institution * Year of passing * % of Marks Scored * Action Add Other
13. Details of Application Fee remitted through online: Amount * Bank * Branch * UTR No. * Date *
Declaration I hereby solemnly declare that information given above are true and correct to the best of my knowledge and belief. If any of the information furnished above is found to be incorrect, the Institution has the right to terminate my candidature at any time / stage and initiate action against me under the law.
Place *
Upload Signature (Max size 50KB) * ( File should be an image file ie jpg, jpeg, png )
Validation code:	Enter the code above here : Can't read the image? click here to refresh.