BETZ ENGINEERING & TECHNOLOGY ZONE

BETZ EDUCATIONAL & RESEARCH DIVISION

21- Dharakeshwari Nagar, 1st Street, Sembakkam,
Chennai - 600 073, India.
Telephone : +91 44 22780291 Mobile : +919551665683 / 9551665684

REGISTRATION FORM
NDT LEVEL-II Training & Certification
Name

Father's Name

Date of Birth

BETZ Membership Number

Organisation/ Company

Address for Coresspondence

Mobile No.

Office Phone No.

E-mail

New

Have You been Trained and Certified by

BETZ as an Inspector ?
Registartion For:

Yes

Month

No
Year

For BETZ ASNT Level-II Shedule of 2015 Please Refer our

Website www.welding-cer

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Payment Detail
Amount
Mode of Payment

DD

Cash

D.D.No
Bank
Date
Note : DD infavour of "BETZ Engineering & Technology Zone", Payable at Chennai.
I request you to kindly register my name for the NDT Training & Certification .
Signature:

Date :

For Office use:

Registration Approved By:

Course Material Issued:

Yes

No

Date:
Ref: BETZ/NDT-REG-001/2015

Mode of issue:

Hand

Courier

Date:

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Date: