Passport
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IIMM EXPERT CERTFICATION PROGRAMME
APPLICATION FOR CERTIFICATION AS CMM/CSM/CLM/CMP/CSP/CLP*
( * Strike out whichever is inapplicable.)
( CMM-CERTIFIED MATERIALS MANAGER; CSM- CERTIFIED SOURCING MANAGER; CLM- CERTIFIED LOGISTICS MANAGER
CMP- CERTIFIED MATERIALS PROFESSIONAL; CSP- CERTIFIED SOURCING PROFESSIONAL; CLP- CERTIFIED LOGISTICS PROFESSIONAL)
INSTRUCTIONS TO FILL IN THE APPLICATION FORM:
1. Fill in the application by writing in block letters or by typing. Where there is no relevant data, write “Not Applicable” or
“N/A”.
2. Attach scanned copies of Degree/Diploma certificates and other relevant documents/testimonials.
3.Please e-mail completed application forms with attachments to: iimmbg@airtelmail.in .
Hard copy of the application form with enclosures should be despatched to:
Deputy Chairman, E-learning
Indian Institute of Materials Management,
# 304, 306 & 307, 'A' Wing, III Floor, Mittal Tower, No. 6, M.G. Road, Bangalore-560001.
Phone: (080) 25327251/52
FEE STRUCTURE AND PAYMENT INSTRUCTIONS:
CMM/CSM/CLM
CMP/CSP/CLP
i)
Application Fee
Rs.5,000/-
Rs.3,000/-
ii)
Evaluation and Certification Fee
Rs.40,000/-
Rs.30,000/-

All payments should be made by DD only drawn in favour of “IIMM NHQ collection account” payable in
Mumbai.
DD should be sent along with the application to our Bangalore address given above.


Payment may also be made at ICICI Bank directly to: ICICI Bank Account No: 015101027881
at Vashi Branch, Navi Mumbai. The original stamped counterfoil of the pay-in-slip with details of remittance
should be sent to us..
We have now on-line payment facility details of which will be provided on request.
Note: (a) Evaluation and Certification Fee includes the Fee for Life Membership of the Indian Institute of
Materials Management (IIMM).
(b) Application Fees and Evaluation and Certification Fees, once paid, will not be refunded under any circumstances.
Section – A
Category and stream applied for :
(CMM/CSM/CLM/CMP/CSP/CLP)
First name
Surname
Middle name
Date of Birth
DD/MM/YYYY
Gender: Male
Female
Contact details
Where do you prefer to be contacted
ORGANIZATION &POSITION:
Name of Organisation
Position held / Job Title
Address
Telephone
Email
Mobile
Total Experience
Relevant Experience in the stream
applied for
HOME:
Address
Telephone
Personal Email
PAN number
Organization
Home
Passport Number
Countries visited
Are you Life member/Ordinary member/
Life Member
Ordinary Member
Non-Member
Non-member of IIMM?
If you are a non-member, how did you
know about IIMM?
Friends
Professionals
Website
Others(Specify)
Have you participated in any IIMM events in the last 3 years? If so, name the events:
Section - B
EDUCATION
(Start from the highest qualification)
SL NO
COURSE
INSTITUTION
LOCATION
YEAR OF PASSING
REMARKS
EMPLOYEMENT
(Start from the present employment and go back chronologically)
SL NO
ORGANISATION
DESIGNATION
LOCATION
Describe the structure of your present organisation and your team
REPORTING TO
DURATION(years)
How many employees report to you?
Direct
Dotted
To whom do you directly report?
Current Salary Band
in Rs.lakhs per annum
Upto 10L
Above 10L&upto 15L
Above 15L & upto 20L
Above 20L
Section – C
1.
Describe your current position and responsibilities. Mention the key performance indicators (KPI) in your
organisation
2.
Describe your career till date.
3.
Have you received any Awards and Recognition in your career? Describe.
4.
Have you written any articles or presented papers on a subject pertaining to your profession in the last 3 years?
Describe
5.
Mention your participation in relevant conferences, workshops, guest lectures etc..
6.
Have you held any leadership positions outside your employment (eg, public appointment, non-executive role or trusteeship).
Describe.
7.
Mention your top five Skills and competencies
8.
Briefly describe your reasons for applying for this Certification and how you are hoping it will help you develop as
a leader.
9.
How do you think you could contribute to the Materials/Sourcing/Logistics Management group?
10. What leadership challenges would you like to face in future?
11. Mention the Trade Associations you are associated with.
12.
Is there any other information that you like to share with us ?
13.
This Application is being forwarded through _________________________________ Branch of IIMM.
Section – D
DECLARATION
I solemnly declare that the information given in the application form and the statements
accompanying it are correct and complete to the best of my knowledge and belief and that the
submissions made along with the application are original.
I hereby promise that, upon receiving the Certification, I will abide by the Code of Ethics and the
Rules and Regulations of IIMM.
(Signature of Applicant)