GLOBAL INSTITUTE OF INTELLECTUAL PROPERTY APPLICATION FORM Six Months (full‐time) Dual Certification Program on International Patents & Intellectual Property Services INSTRUCTIONS • This form is divided into Section A, B, and C. • Please fill in the personal details, such as contact information, educational qualification and work experience, if any in Section A. • Answer all the questions in Section B. This section will be evaluated by the GIIP Selection Committee for assessing the eligibility for enrolling in the program. • Specify your choice of centre for taking the program, requirement for education loan etc. in Section C of this form. • Section D is for Office Use Only. • If your profile is found suitable, you will be informed about the process of taking the Online Entrance Test, which is a pre‐qualification for enrolling in the program. Personal Information ............................................................................... Section A Assessment Questions ............................................................................... Section B Misc Course Related Information ............................................................................... Section C For Office Use ............................................................................... Section D PREFERRED LOCATION FOR TAKING THE DUAL CERTIFICATE PROGRAM: (Please put 1, 2, 3, 4 against each centre in order of your preference) Gurgaon Mumbai Chennai SECTION A: PERSONAL DATA Name: Title: CONTACT INFORMATION Residential Address: Office Address: Telephone# (Home): Telephone# (Office): Mobile#: Email id: Date of Birth: Gender: Page 1 of 4 Bangalore EDUCATIONAL QUALIFICATION (Graduation and Above) Name of Board/University Year of Subjects Institution passing % (major) Degree/Diploma/ Certificate Obtained WORK EXPERIENCE (Current Employment to First Job) Name of the Current Organization Designation Start date – Area of Work End date Experience, if any, in the field of Patents and/or IP SECTION B: ASSESSMENT QUESTIONS Kindly take time to write answers for this section. This section will be evaluated by the GIIP Selection Committee for enrolment in the program. Please do not leave any question unanswered. Use Additional Sheets, if required. 1. Please describe below your special academic interest(s) and objective(s) in undertaking this program (max. 500 words) Page 2 of 4 2. How did you get introduced to Intellectual Property and/or Patents? Have you taken any formal training in Intellectual Property Rights and/or Patents? If yes, please list the courses/programs, seminars, workshops you have attended. 3. Do you feel Patents and Intellectual Property Rights will contribute to the growth of the Indian economy? If yes, why? And why do you think that a career in Patents and Intellectual Property Rights can be rewarding and pertinent in today’s globalized world. 4. Do you have any research experience? If yes, please describe in detail. Also list publications in domestic and international journals, if any. 5. Please list any extracurricular or work experience that you would like us to know about and any honours/awards, you have received. Page 3 of 4 6. How did you come to know about the program? (Please tick) Newspaper Advertisement Journals/Magazines/Newspaper Articles Please specify the name of the Newspaper/Journals etc. Online Search Mailer From GIIP Friends Others (Please Specify) SECTION C: MISC. COURSE RELATED INFORMATION ARE YOU A SPONSORED CANDIDATE OR SELF FINANCING CANDIDATE? Yes No DO YOU WISH TO SEEK EDUCATION LOAN FROM HDFC BANK: (In this case, your profile will be forwarded to HDFC bank for eligibility assessment) Yes No IMPORTANT NOTE: The Dual Certification Program is GIIP’s and CASRIP’s independent professional skill enhancement programs, aimed at providing hands‐on and practical training in field of Patents and Intellectual Property services, coupled with academic insights into the Patent Systems. This program is not covered under AICTE. In case of any dispute, it would have to be got resolved through arbitration under Arbitration and Conciliation Act 1996 by the sole arbitrator appointed by Global Institute of Intellectual Property at New Delhi. Fee once deposited is neither refundable nor adjustable under any circumstances. DECLARATION BY THE CANDIDATE APPLYING FOR THE PROGRAM I hereby declare that I have read and understood the conditions of eligibility for the course to which I seek admission. I fulfil the minimum eligibility criteria and I have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the institute at any time and I shall not be entitled to refund of any fee paid by me to the Institute. Name of the candidate Date Place Signature SECTION D: FOR OFFICE USE Online Test Marks: Overall Marks: Enrollement Loan Required: If yes, details provided to HDFC Remarks (if any): Eligible Eligible Accepted Yes Yes (Date: Page 4 of 4 ) Not Eligible Not Eligible Not Accepted No No