Indian Institute of Technology Delhi Executive Management Programme in Strategic Innovations, Digital Marketing & Business Analytics

I, ___________________________ (last name) ________________________ (first name) with date of birth (DD/MM/YY):_________________ certify that the information provided by me in the application form is correct. I hereby enclosing the document copies to support the given details. I understand that my application or candidature in the programme will be cancelled, if any discrepancy is found later.

________________________ Your photograph

(Signature) Date:______________________

here

______________ Please send this declaration form and the copies of your documents to:

Dr Arpan Kumar Kar, Course Coordinator - EMP - Strategic Innovations, Digital Marketing, & Business Analytics Department of Management Studies, Vishwakarma Bhawan, IIT Delhi, Hauz Khas, New Delhi-110016.