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REGISTRATION/ENROLMENT FORM

Please read the terms and conditions before completing this form all Blanks Must be Filled in Block Letter and Enclosed One Copy of your Recent Photograph.

[01] Applicant's Name

[02] Father's Name / Husband Name

[03] Mother's Name

[04] Mailing Address

[05] Permanent Address

[06] Tel

Cell

E-mail

[07] Date of Birth

[08] Sex

Male

Female

[09] Marital Status

Single

Married

[10] Class/Subjects in which admission sought

[11] Educational Qualification/Previous travels [if any]

Academic Qualification

Exam Title	Year	Examining Board/ Institution	Degree obtained (Division/ Class/ GPA)

[12] Professional/Other Qualification

[13] Name & Qualification of Spouse

[14] Choice of Country

[15] College/University [of first choice]

[16] Passport /NID No. [if any]

[17] Purpose of Visit [Specify]

[18] IELTS/ TOFEL [if done]

[19] Reference's Name & Contact No.

I do here by confirm that the above particulars are true. In case any change in rules & regulations of a country or an institute in any situation Intermech Int'l. [ I&I ] consultant will not be liable for that.

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