IIRMINSTITUTE OF INSURANCE AND RISK MANAGEMENT

(Jointly set up by IRDA and Government of Andhra Pradesh)

Plot No: 38/39, Financial District, APSFC Building,Ground Floor, Nanakramguda, Gachibowli, Hyderabad - 500 032,
Ph No: +91 40 23000005, Fax: +91 40 23000254 Email: email@iirmworld.org.in, Website: www.iirmworld.org.in

FORM FOR ADMISSION TO INTERNATIONAL POST GRADUATE DIPLOMA

Course applied for IPGDI (Life) IPGDI (General) IPGDRM (Risk Management)

Application form No: to be filled by IIRM office.

To be filled in block letters by the applicant
Name of the candidate:
Date of birth: Age: Sex: Male Female
Email Id:
Fathers Name:
Postal Address for communication:
City:
Pin: State: Phone Mobile
Academic background:
Name of the College/Institution: Place
Name of the Course: Specialization:
Graduation/Post Month/Year of Board/University Marks obtained Aggregate Percentage
Graduate Details passing

Work Experience (if any):

Academic Honours / Extracurricular activities:

Send completed application along with DD in favor of IIRM, payable at Hyderabad for Rs.300/-
DD No: Date: Bank:

The completed application form should be mailed to I declare that the information furnished in this application is true to
Managing Director, Institute of Insurance and Risk the best of my knowledge and I further expressly understand my
Management, Plot No: 38/39, Financial District, APSFC admission is subject to satisfying the requirements of the IIRM and
Building,Ground Floor, Nanakramguda, Gachibowli, I shall abide by all the rules and regulations of the institute
Hyderabad - 500 032. applicable from time to time.
Note:
1. The attested copies of certificates of Degree/Professional Date:
Qualifications/Experience are to be submitted only at the time of Place: Students Signature
interview.
2. Those who are appearing for the Graduation Final Year Exam have to
submit the proof of having passed the examination with minimum 50%
Admission Status: Approved / Not Approved
marks before commencement of classes. Admission of such selected
candidates will be on provisional basis.
3. If the space provided is not sufficient, please attach information in a
separate sheet of paper
4. All disputes are subject to the jurisdiction of the courts at Hyderabad. Date: Managing Director