Reg. No............................

To be filled in by office after confirmation of Registration

REGISTRATION FORM

THREE MONTHS CERTIFICATE COURSE IN ‘INSOLVENCY AND BANKRUPTCY LAWS & PROCEDURE’

(Online) – Eighth Batch (July – Sept 2020)

Course Fee INR 38940 INR 51920 (Including Taxes) (Including Taxes)

Affix your latest Photograph

1. Title: Mr. Ms.

2. First Name......................................... Middle Name......................................

Last Name..........................................................................................

............

3. Gender M

F

Sign

4. Date of Birth...................................................

(DD/MM/YYYY)

5. The acceptable categories of the ID proof are as follows:

Passport Driving License Pan Card Voter ID Aadhar Card

PAN No ………………………………………. (mention here)

6. Name of the College/Company/Firm/Organization

.......................................................................................................................................................................

7. Post Address.............................................................................................................................................

..................................................................................................................................................................

8. Postal Code......................................

9. Contact No......................................................... Mobile............................................................................

10. Fax No. ............................................ 11. Email address...................................................................

12. Designation of working professional.........................................................................................................

13. Disability: Yes/No

14. If yes please specify the nature.................................................................................................................

15. Mode of Payment : DD/Online Payment: NEFT/RTGS.

16. Demand Draft No. / NEFT/ RTGS Transaction No.............................................

Amount....................................... Date ................................... Bank Name ..............................................

Branch ....................................... in favour of ‘Indian Institute of Corporate Affairs” payable at New Delhi.

17. From which source you come to know about this course(Mention Name):..........................................................

18. I, .......................................................................... do hereby declare that furnished information is true to the best

of my knowledge and belief.

Date :

Place: Signature of Applicant

Please send the duly filled in REGISTRATION FORM along with the following documents to:

Make the payment of applicable fee by way of Demand Draft in favour of “Indian Institute of Corporate Affairs” payable at New

Delhi or NEFT/RTGS.

Enclose Demand Draft in original or online receipt of NEFT/RTGS

Self attested photo ID with Address Proof (e.g. passport, Aadhar Card etc.)

“Course Director, School of

Bank details for payment by RTGS/NEFT

Corporate Law, Indian Institute of

Corporate Affairs, Plot No. 6,7,8, Account Name: “Indian Institute of Corporate Affairs”

Sector – 5, IMT Manesar, Bank Name: Bank of India Current Account No.: 6048 1021 000 0007

Gurgaon, Haryana 122050, India.” Branch Address: Electronics Niketan, CGO Complex

IFSC Code No.: BKID 0006048 MICR Code No.: 110013052

Email: scl@iica.in

RTGS/NEFT Code No. ........................................ Branch Code