AIMA CERTIFIED TRAINER (ACT)
APPLICATION FORM
Name :
Date of Birth(DD/MM/YYYY): 
Designation:  Organization: 
ADDRESS FOR CORRESPONDENCE
City: Pincode:
CONTACT DETAILS
Mobile: Alternate Telephone No. : Email
EXPERIENCE (NO. OF YEARS) As a Trainer
In service not related to Training
ACADEMIC ACHIEVEMENTS
Qualification Degree / Diploma University / Institute Year of Passing
Graduation
Post Graduation
Ph.D.
Any Other
Accreditation / Certification as Teacher / Trainer
DETAILS OF TRAINING DELIVERED
Organization / Client Title of the Training Program Duration of the Module Delivered Date of Delivery
LIST OF ENCLOSURES
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