Name of Course : SUJOK BASIC

Name of Lecture : Date : __________________to_______________________

Contact No.
No Name of the Participant Gender Address
(M)

: : CERTIFICATE : :
I, here by certify that above mentioned candidates are being trained & examined by me on______

Further I certified that I have deposited sum of Rs. ____________________ as 10% administartive fees on
 Place : Fees per candidate :
_______________ Total Participants :

Contact No. ISA Member

Email ID Educational Qualification
(R) (Yes/No)

CERTIFICATE : :
examined by me on______________ and they are qualified to receive certification.

10% administartive fees on_____________ in ISA, Nagpur Account by Cash / cheque / DD.