An Educational Initiative by SEBI

Certificate in Securities Law

Affix Passport size photograph here

First Name:

Middle Name:

Last Name:

Gender: Male

Female Single Age: Nationality:

Marital Status: Married Date of Birth (DD/MM/YYYY): Occupation: Address for Communication:

Residence Tel. No.: Office Tel. No.: Fax No.: Mobile No.: Email:

Permanent Address (If different from address for communication):

Page 1

I hereby certify that the above information given is true and correct to the best of my knowledge.A.. I understand that any false declaration shall result in disqualification of my admission to CSL. B.Com.EDUCATIONAL QUALIFICATION Name of Degree: Name of the University: Year of Passing: ACADEMIC PROFILE Exam Name of the Exam / Subjects Month & Year Name of School % of of passing / college Marks obtained Name of the Board / University SSC HSC Graduation (Specify) B. code of conduct and students’ guidelines framed/to be framed from time to time.: Bank’s Name and Branch: Date (DD/MM/YYYY): I agree to abide by NISM’s rules. Applicant’s Signature: Place: Date: Page 2 .B. Others Post Graduation Others WORK EXPERIENCE DETAILS Total Work Experience: Organization Years : Months: Till Designation Nature of Duties From PAYMENT DETAILS Amount: `500/DD / Pay Order No.

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