Registration for PGDPHM and DPHM Courses
Course (PGDPHM/ DPHM) :
-Select-
PGDPHM - 12 Months
DPHM - 6 Months
Full Name
*
Gender :
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MALE
FEMALE
OTHER
Date of Birth :
*
* Please select Date of Birth
Category :
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SC
ST
OBC
EWS
DIVYANG
GENERAL
Father's Name :
*
Mother's Name :
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Occupation of Parents :
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Annual Income of Parents (in Rs.) :
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* Input digits (0 - 9)
* Please enter your Parents Income
Present Postal Address :
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* Please Enter Trainee Address
Permanent Address :
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* Please Enter Trainee Address
Email :
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* Please Enter Office of Trainee
Mobile No. :
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* Input digits (0 - 9)
* Please Enter Mobile No.
Educational Qualifications :
*
Qualification
Board/ University
Subject/ Specialization
Marks/ Grade
Division
Year of Passing
SSC
Intermediate (10+2)
Graduation
Post Graduation
Any Other
Ranks / Awards / Achievements (if any)
Please Provide your RTGS Payment Details
UTR No. :
*
Date of Payment :
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* Please select Date of Payment
Declaration
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I hereby declare that all the information furnished above by me are true and correct to the best of my knowledge and belief. I agree to abide by all the rules, codes and conduct as may be framed from time to time by the institute.
Date :
Place :
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Upload Passport Photo (200x160 px)
(Only JPG files < 50 kb):
Only JPEG images are allowed
File Size > 50 Kb
Upload Qualification Certificates as a single file
(Only PDF Files < 1 Mb):
Only PDF Files are allowed
File Size > 1 MB
Any technical difficulties in filling-up online application may be mailed to : adict-niphmhyd@gov.in
If not able to submit the application online, alternatively you can download the application
here
and mail the filled-in application to : jdenggniphm-ap@nic.in