IIMM CMP CERTIFICATION APPLICATION FORM

Instruction to fill in the application form:

1. All the details mentioned in the form are to be responded to, in block letters.

2. Please be informed that only fully completed application forms will be eligible for screening.

3. In places where there is no relevant data, please indicate “Not Applicable / NA”.

4. Attest scanned copy of document wherever necessary. Scanned copies of the following documents are mandatory: Degree certificate and PAN card.

5. Please e-mail completed application forms with attachments to: .

Forms may also be mailed to:

Deputy Chairman E-learning

Indian Institute of Material Management, Bangalore

# 304, 306 & 307, 'A' Wing, III Floor, Mittal Tower, No. 6,

M.G. Road, Bangalore-560001.

Phone: (080) 25327251/52, Fax: (080) 25327253

Payment Instructions:

1. Registration fee of Rs.3000/- waived off till 30th April 2013. The total fee for Certification is inclusive of IIMM Life membership fee worth Rs.7500/- which is applicable for deduction for existing life members. Early birds can avail concession upto. Rs.10,500/-

2. All payments should be made by DD only in favor of “IIMM NHQ collection account” payable in Mumbai.

DD should be sent to:

Indian Institute of Materials Management-NATIONAL HEADQUARTERS

Plot Nos. 102 & 104, Sector - 15, Institutional Area

CBD Belapur, Navi Mumbai - 400614

3. Payment may also be made at ICICI Bank directly to ICICI Bank Account No: 015101027881
at Vashi Branch, Navi Mumbai.

In case of direct deposit, please send us the original stamped counterfoil of the pay-in-slip with details of remittance. (Kindly send scanned copies through email, of the pay-in-slip so that processing commences as soon as possible)

4. Application fees will not be refunded under any circumstances.


Section – A

I would like to apply for:
Preferred location

Your details

First name
Surname
Middle name
Gender / Male / Female

Organisation / Residence contact details

Preferred contact address / Work / Home
Organisation name
Position / Job Title
Work address
Work Telephone
Work Email
Mobile
Home address
Home Telephone
Personal Email
PAN number
Passport Number
Countries Visited:
Total Experience
Relevant Experience in the applied field of certification
Are you life member of IIMM?
Have you participated in IIMM events? Mention if any in last 3 years
How did you know about IIMM? / Friends / Professionals / Website / Others (Specify)


Section - B

EDUCATION DETAILS

(Start from graduation, post graduation and any other relevant academic certifications/Diploma)

SL NO / COURSE / INSTITUTION / LOCATION / YEAR OF PASSING / REMARKS

Have you attended any Training / certification in last 3-5 years?

EMPLOYEMENT DETAILS

(Start from the current organisation to previous)

SL NO / ORGANISATION / DESIGNATION / LOCATION / REPORTING TO / DURATION
Describe your current organisation Structure and Team
Do you have anyone reporting
Direct :
Dotted:
Mention your top Five Skills and Competencies :
Current Salary Band / (Upto 10L) / (10L-15L) / (15L-20L) / (20L and above)


Section – C

Have you received any Awards & Recognition in career?
1. Describe your current position and responsibility and productive indicators (KPI) in the organisation
2. Provide a brief biography that describes your career to date; include any leadership positions outside your employment (eg, public appointments, non-executive role or trusteeship).
3. Have you written any articles, white papers on the subject in last 3 years? Mention your association with relevant forums, guest lectures etc..
4. Briefly describe your reasons for applying for this Certification and how you are hoping it will help you develop as a leader.
5. How do you think you would contribute to the Material Management and Logistic group?
6. What leadership challenges do you like to face in future?
7. Mention the Trade associations you have associated with:
8. Is there any further information that you think we should have?

Section - D

DECLARATION

I solemnly declare for and on behalf of that to the best of my knowledge and belief, the information given in the application form and the statements accompanying it are correct and complete. Submissions made along with application are original.

I hereby promise on behalf of IIMM to abide by the Rules and Regulations of IIMM. I understand and accept that in case, at any point of time, the information furnished by me for and on behalf of IIMM found to be incorrect; the membership of IIMM is liable to be terminated without notice and without any liability on the part of IIMM.

I further understand and accept that IIMM reserves the right to reject the application for membership without ascribing any reason whatsoever.

For and on behalf of

(Signature of applicant)