NATIONAL INSTITUTE OF CONSTRUCTIONMANAGEMENT AND RESEARCH

SCHOOL OF DISTANCE EDUCATION

RCC/EXAMINATION ENROLMENT FORMSEPTEMBER 03-15, 2012

1. Name : ________________________________________________________

2. Registration Number : ________________________________________________________

3. Mailing Address : ________________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Tel: _____________________ e-mail: _______________________

4. Course : _____________________ Module _________________________

5. Centre :

Regional Contact Classes: (September 03-07, 2012)

Sr. Subject Date Presence Amount D.D. No. & Bank &No. (Y/N) Date Branch

1.

2.

3.

4.

Examinations: (September 08-11, 2012)

Sr. No. Course No. Course Title Module Assignment Submitted

1.

2.

3.

4.

5.

6.

Computer Proficiency Programme: (September 12-15, 2012)I wish to enrol for the Computer Proficiency Programme of four days and paying the fee of Rs. 11,236/-(Rs. Eleven Thousand Two Hundred and Thirty Six Rupees Only).

D.D. No. Date Bank & BranchSignature: ___________________

Date:________________________

Yes No

Rs. 3,090/-

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No