APPLICATION FORM

Programme Applied for: (Tick Mark)*

DISTANCE LEARNING PROGRAMMES
Diploma Programme in Paint & Coating Technology DPCT
Advance PGD in Paint & Coating Technology PGCT
Advance PGD in Powder & Resin Technology PGRT
Advance PGD in Surface Coating Technology PGST
2 Yr PGD in Paint Technology & Allied Sciences PTAS
3 Yr PGD in Paint Engineering PENG
Industry Diploma in Automotive Coating & Corrosion Treatment DACT
Advance PGD in Automotive Coating & Corrosion Treatment PGAC
Industry Diploma in Coating Inspection & QC (Level 1) DCIQ
Advance PGD in Coating Inspection & QC (Level 2) PGIQ
Advance Industry Diploma in Leather Technology IDLT
Advance PGD in Leather Technology PGLT
Advance Diploma in Plastic & Fiber Technology DPFT
Advance Diploma in Paper & Pulp Technology DPPT
Advance Diploma in Sugar & Alcohol Technology DSAT
Advance Diploma in Event Management ADEM
Advance Diploma in Tour, Travel & Logistics ADTL
ONLINE CLASSROOM PROGRAMMES
Diploma Programme in Paint & Coating Technology DPCT-CL
Advance PGD in Paint & Coating Technology PGCT-CL
Advance PGD in Powder & Resin Technology PGRT-CL
Advance PGD in Surface Coating Technology PGST-CL
2 Yr PGD in Paint Technology & Allied Sciences PTAS-CL
3 Yr PGD in Paint Engineering PENG-CL
Industry Diploma in Automotive Coating & Corrosion Treatment DACT-CL
Advance PGD in Automotive Coating & Corrosion Treatment PGAC-CL
Industry Diploma in Coating Inspection & QC (Level 1) DCIQ-CL
Advance PGD in Coating Inspection & QC (Level 2) PGIQ-CL

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PERSONAL DETAILS ( All in Block Letters)

1. Name*:
2. Father’s Name*:
3. Date of Birth*:
4. Gender*:
5. Correspondence Address*:
6. Postal/ZIP Code*:
7. Email ID*:
8. Mobile No*.
9. Nationality*:

ACADEMIC / WORKING DETAILS

Last Academic Qualification* Exam Passed Board / University Year
Working Experience (if applicable) Name of Organization Designation Total Work Experience

PAYMENT DETAILS

Mode (Tick Mark)*
For Amount (In Words)
For Amount (In Figure)
*Mandatory to fill
** Important Note:
The program in which you are seeking participation, is AIPS's independent knowledge enhancement program, which gives insight about mentioned study areas. The program does not promise any job guarantee nor provides any specific eligibility to pursue higher studies.

This is not a University / Government Program. In case of any dispute, it would have to be got resolved through arbitration under Arbitration and Conciliation Act 1996 by the sole arbitrator appointed by AIPS , Noida. The jurisdiction of the same will be to the Courts of District Gautam Buddha Nagar, Noida only. Fee once deposited is neither refundable nor adjustable under any circumstances. Terms ,Conditions and Procedures of Examination , Mark Sheet & Certificate will be under the jurisdiction of AIPS NOIDA.
**Declaration by the Candidate
I declare that I have carefully read and understood the details of the above program and that I have given the true and correct information while filling up the form. It may be open for the Institute to take action in case any of the information given by me is found incorrect.