Nomination Form (Page 3 of 3) in pdf

INSTRUCTIONS TO FILLUP THE NOMINATION FORM

Fields with

are mandatory.

1. Provide your full name in English & Hindi (optional).

2. Provide your Father’s Name / Spouse’s Name.

3. Provide your Service / Cadre type along with your Grade/Rank.

a) CSS & Equivalent Service: Joint Secretary / Director / Deputy Secretary / Under Secretary / Section

Officer / Assistant.

b) CSSS & Equivalent Service: Executive PPS / Senior PPS / PPS / PS / PA / Steno-C / Steno-D.

c) CSCS & Equivalent Service: UDC / LDC.

d) AIS: Secretary / Special Secretary / Additional Secretary / Joint Secretary / Director / Deputy Secretary /

Under Secretary.

e) Indian Army: General / Lt. General / Major General / Brigadier / Colonel / Lt. Colonel / Major / Captain /

Lieutenant.

f) Indian Navy: Admiral / Vice Admiral / Rear Admiral / Commodore / Captain (IN) / Commander / Lt.

Commander / Lieutenant (IN) / Sub Lieutenant.

g) Indian Air force: Air chief Marshal / Air Marshal / Air Vice Marshal / Air Commodore / Group Captain /

Wing Commander / Squadron Leader / Flight Lieutenant / Flying Officer

h) Other: If any Grade/Rank other than the above mentioned option, please provide the details.

4. Provide your Date of joining / last promotion (DD-MM-YYYY).

5. Provide your Pay band.

6. Provide your Grade Pay / Scale of Pay.

7. Provide your Gender (Male / Female)

8. Provide your Date of Birth (DD-MM-YYYY).

9. Provide your Oraganisation Name.

10. Provide your Oraganisation Type (Ministry / Department / PSU / Defence / Constitutional and Statutory

Bodies / CAB / NGO / Foreign / others).

11. Provide your Organisation street name.

12. Provide your Organisation City name.

13. Provide your Organisation State name.

14. Provide your Organisation area PIN Code.

15. Provide your Organisation Email ID.

16. Provide your Organisation phone number with area code.

17. Provide your Residence street name.

18. Provide your Residence City name.

19. Provide your Residence State name.

20. Provide your Residence area PIN Code.

21. Provide your personal Email ID.

22. Provide your personal phone/mobile number with area code.

23. Provide your Category (SC / ST / OBC / GEN).

24. Provide any Emergency Contact details (Phone / Mobile number).

25. Provide your Educational Qualification (from Higher to Lower).

26. Provide your Service to which belongs.

27. Provide your brief Service particulars as per the details provided in the column.

28. Tick ‘Yes’ if eligible, else ‘No’.

29. Tick ‘Yes’ if Hostel accommodation required else ‘No’.

30. Provide short description about the benefit of this training for individual and Organisation.

31. Provide the details of your earlier applications for the same course.

32. If any courses attended at ISTM previously, then provide the course name & date, else write ‘No’

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Nomination Form Page 3

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