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REGISTRATION FORM

Official Information:
Company / Institution Name:
__________________________________________________
Name of Participant:
________________________________________________________
Designation of Participant:
___________________________________________________
Products / Services of your Company:
___________________________________________

Contact Information:
Corresponding Address:
___________________________________________________________________________
_________________________________________________________________________Ci
ty: ___________________________________ State: _____________________________
Mobile: ________________________________ Landline:
___________________________
PARTICIPATION FEE (per participant):
5000 + S.T. =
5725
6000 + S.T. =
LATE FEE - May 16th onwards
6870
Note: Payment can be done through Cheque / DD / NEFT.
April 16th - May 15th 2016

Bank Details:
State Bank of India
Name of A/c holder
Type of Account
Branch
Account No
Place
Bank Code
MICR Code

: ProSIM R&D Pvt Ltd


: CA
: Rajajinagar Industrial Estate Branch
: 30029502347
: Bangalore 560044, Karnataka
: 00762
: 560002042

ProSIM R&D Pvt. Ltd.


#4, 1st B Main, 1st N Block, Rajajinagar, Bangalore 560010
Phone: +91-80-23323020 / 41277793 | Web: www.pro-sim.com | Email:
info@pro-sim.com

IFSC Code

: SBIN0000762

KINDLY EMAIL THE FILLED FORM BACK TO vibration.analysis@pro-sim.com OR POST /


COURIER US THE HARD COPY TO THE BELOW MENTIONED ADDRESS.

ProSIM R&D Pvt. Ltd.


#4, 1st B Main, 1st N Block, Rajajinagar, Bangalore 560010
Phone: +91-80-23323020 / 41277793 | Web: www.pro-sim.com | Email:
info@pro-sim.com