TRAINING REGISTRATION FORM

STUDENT FULL NAME

(As mentioned in College ID)

STUDENT DATE OF BIRTH STUDENT FATHER NAME AND OCCUPATION CORRESPONDENCE ADDRESS WITH TELEPHONE NUMBERS AND EMAIL ID PERMANENT ADDRESS WITH TELEPHONE NUMBERS AND EMAIL ID QUALIFICATION (GRADUATE/POST GRADUATE) DISCIPLINE HOD NAME, CONTACT NUMBER AND EMAIL ID COLLEGE NAME AND ADDRESS UNIVERSITY (Your College Affiliation) SELECTED TRAINING MODULE INTENDED DATE OF JOINING TRAINING FEES RS. HOW DID YOU CAME TO KNOW ABOUT CREDORA YOUR FRIENDS/CLASSMATES NAME JOINING FOR TRAINING DOCUMENTS REQUIRED WITH FILLED REGISTRATION FORM TRAINING REGISTRATION AMOUNT DETAILS 1.College ID Card photocopy 2.Resume 3.Passport Size Photos2Nos. 4.Training Registration Amount Rs.: DD* No.:. Bank:.. WEBSITE / MAGAZINE / COLLEGE / FACEBOOK SEARCH ENGINE / FRIENDS MICROBIOLOGY / BIOTECHNOLOGY / MOLECULAR BIOLOGY / BIOCHEMISTRY

* DD (DEMAND DRAFT) to be taken in favour of CREDORA LIFE SCIENCES., payable at Bangalore. Declaration: I do hereby agree to all the rules and regulations of the Company Student Signature, Name with Date FOR OFFICE USE 1. Student Registration No.: 2. Regitration Payment Details: 3. Payment on Admission Day Details:
Receipt No.

Receipt Date
Receipt No.

Receipt Date

Credora Life Sciences, #40, SS Grand, 2nd Floor, 100ft Road, HRBR layout, Banaswadi Main Road, Bangalore 560 043