Online EDP Registration

Photograph:
1 Name:
2 Date of Birth:
3 Gender:
4 Address Line 1:
5 Address Line 2:
6 Address Line 3:
7 City:
8 State:
9 Pin code:
10 Mailing Address:
11 Mobile Number:
12 Alternate Mobile No:
13 Land Line Number (Res):
14 E-Mail ID:
15 Alternate Email ID:
16 Education, Year of passing, Certifying body:
17 Work Experience:
18 Current Occupation:
19 Industry /Sector:
20 You may transfer the initial payment of the Program fee INR 30000/- to IIMK LIVE bank account through online/offline mode and provide the Transaction ID/Receipt number in the below option.
Bank account details
Account Name IIMK LIVE
Account Number 35841048720
Bank Name State Bank of India
Branch IIM Kozhikode Campus
Address SBI, IIM Kozhikode Campus, PO: Kozhikode,
Kerala - 673 570
IFSC Code SBIN0010565 :