BSE Training Institute

A Division of BSE Limited

18th & 19th Floor, P J Tower, Dalal Street, Fort, Mumbai - 400 001

Phone: 022 2272 8464/8862/8121/8859/8813/8175/8246/8062/8247; Fax: 022 2272 3250

E Mail: training@bseindia.com, Website: www.bseindia.com

REGISTRATION FORM

NAME OF THE PARTICIPANT (Please keep a space between two words)

BANK / FINANCIAL INSTITUTE

BROKING HOUSE

INDIVIDUAL

MARKET INTERMEDIARY

STUDENT

OTHERS

NAME OF THE PROGRAMME :

DATE OF THE PROGRAMME :

RESIDENTIAL ADDRESS

COMPANY NAME & ADDRESS

LINE 1 :

LINE 1 :

LINE 2 :

LINE 2 :

CITY :

CITY :

AREA/DISTRICT :

AREA/DISTRICT :

STATE :

PIN

STATE :

PIN

MOBILE NO

0

RESIDENCE :

0

OFFICE NO

0

FAX NO :

0

E MAIL :

QUALIFICATION :

DESIGNATION :

PAYMENT DETAILS

DD No :

Dated :

−

−

2

0

1

FOR OFFICE USE ONLY

Issuing Bank :

ERP TR No.

Branch :

Receipt No :

Cash Deposit Transaction Number (Bank of India)

HOW DID YOU COME TO KNOW ABOUT THIS PROGRAMME : (KINDLY TICK ON THE APPROPRIATE BOX)

BTI Promotional E mail

News Paper

Economic Times

Business Standard

Business Line

Mid Day

Other Newspaper

Website (Please Specify):

Others :

Place :

Date :

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−

2

0

1

(CANDIDATE'S / SPONSOR'S SIGNATURE)

1. Add 10.30 % towards Service Tax and Education Cess to the course fee amount when making the payment.

2. Registration Form should be accompanied with full payment through a Demand Draft in favour of 'BSE Limited', payable at Mumbai.

3.  If there is more than one participant, the   details of the other participants should be submitted as an annexure.

4. The admission is given on a first-come-first-serve basis.

For Knowledge & Know-how on Capital Market