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REGISTRATION FORM -WINTER INTERNSHIP 2021

OFFLINE/ INSTRUCTOR LED ONLINE (VIRTUAL) MODE
HOST: DRILLING MENTOR PVT. LTD. AHMEDABAD, CONTACT NO. +91 943
You can apply both programs to be executed in 4 batches . Please use separate REGISTRATION FORM for each bat
Registration Form for one batch. Please remit program fee for each program separately through PayUmoney link a
FOR WINTER INTERNSHIP 2021 and keep ready Payment ID with date before filling regist

BATCH 1
Program Code & Title: WI21_B1P1_ DRILLING OPERATIONS AND STANDARD OPERATING PROCEDURES (ONSHORE CYBER/AMPHION RIGS)
(Please copy the program Code & Title and paste in column no.3)
Last date for registration: 31.10.2021, 11.59 PM,
Program start date: 15.11.2021

BATCH 3
Program Code & Title: WI21_B3P1_ DRILLING OPERATIONS AND STANDARD OPERATING PROCEDURES (ONSHORE CYBER/AMPHION RIGS)
(Please copy the program Code & Title and paste in column no.3)
Last date for registration: 31.10.2021, 11.59 PM,
Program start date: 01.12..2021
INSTRUCTIONS TO FILL UP AND SUBMIT REGISTRATON FORM:
1. General : Please choose your batch as per your choice and convenience. Applicants are required to fill up all 11 yellow cells only to complete the Registration Form. Particulars in yellow boxe
change font/ font size/ other text/ data in the Registration form. Please donot deform properties of the excel form. Please donot convert it in PDF. It will remain in Excel only. Registration Form r
shall be made in CAPITAL LETTERS except in column number 5, that is your email address.
2. One Registration Form for One program: Candidates can apply for one or both programs simulteneously. Each program/ course/internship topic shall be applied in separate Registration Form
3. How much and how to pay Registation cum Internship Fee: -Please check in NOTIFICATION FOR Winter INTERNSHIP 2021
-If you are in a group, please mention group leader's name in column number 11.
-Registation cum Internship Fee does not include boarding/ lodging or any other charges.
-Remit fee amount by PayUmoney link https://pmny.in/SIwNThSr2eds also available at BROCHURE/ NOTIFICATION . It can easily connect your net banking account for trouble free remittence
vide A/c No.: 006705005419, Account Type: Current Account, Bank Name: ICICI Bank, Ahmedabad, IFSC : ICIC0000067 in view of the refund rule as mentioned below .
4. How to submit Registration Form (Please keep ready following attachments).
(1) Duly filled up Registration Form (in MS Excel only)
(2) Marks Sheet of any Completed Semester-Scanned Copy
(3) Aadhaar Card/ DL/ Election Card (Any one)- Scanned Copy
(4) Color Photo (Scanned Copy)
(5) Proof of payment(Screen Shot, Scanned copy)
(6) Copy of BPL Card for BPL applicant (Scanned)
Note: Size of each attachment except MS Excel Registration Form should not be more than 200 kb.
5. Filled up REGISTRATION FORM FOR WINTER INTERNSHIP-2021 along with above attachments and mail to info@drillingmentor.com
6. Call Drilling Mentor at +91 9435716886 before and after deposting fee.
7. Incomplete forms shall be rejected.

Call Drilling Mentor at +91 9435716886 before and after deposting fee.
1 START 2 3 4 5 6
NAME OF TRAINEE AS PER COLLEGE UNIVERSITY & COLLEGE NAME/ DEGEE PROGRAM CODE & PROGRAM NAME. MODE OF INTERNSHIP PERSONAL E-MAIL PERSONAL & EMERGENCY NO.
RECORD TYPE/ BATCH SESSION/ CURRENT SEM / PL. COPY ONE PROGRAM FROM DESIRED (Write any one in yellow cell below) (Gmail preferred)
COLLEGE ROLL NO. BATCH AND PASTE HERE. OFFLINE / VIRTUAL

VISHAL VAIBHAV SHRIVASTAVA MIT WPU PUNE/ WI21_B1P1: DRILLING OFFLINE 7487811305
BE PETRO/ OPERATIONS AND STANDARD gophaneh2@gmail.com
8615565302
2017-21/ 06/ OPERATING PROCEDURES
2017P15 (ONSHORE CYBER/AMPHION
RIGS)
Undertaking by the applicant:
1. That I have transferred the program fee to through PAYUMONEY link https://pmny.in/SIwNThSr2eds or NET BANKING DETAILS linked to the account of “Drilling Mentor Pvt. Ltd.” vide A/c N
ICIC0000067 in view of the refund rule as mentioned below.
2. Refund Policy: 100% refund if the program is cancelled by training provider. No refund if cancelled by the applicant.
3. That program login password is not transferable from student to student. Misuse of password will lead to cancellation of registration in running session without any refund.
4. That I agree to perform compulsory class work continuously online to complete course and complile/submit the project work to the mentor on time or time as determined by the mentor.
5. HSE, Security & Drug Abuse Undertaking is included in the registration form. As per following wordings(Not applicable for online programs):
“Food, lodging, any kind of insurance/ expense or compensation with respect to the course/internship, life, health, safety, security, environment, violation of smoking & drug abuse and law & or
for the same Drilling Mentor Pvt. Ltd. shall not be held responsible. I will maintain optimum discipline at the venue of training as per rule applicable for educational institutions and public place f
without any compensation and can be liable to face consequences of local law and order to recover any loss caused by me. Based on above, may please consider my application for registration.
6. Disposal of any dispute shall be within the jurisdiction of Ahmedabad. [Last line reached].

Drilling Mentor Private Limited | 410 | 4th Floor | Swarnim The Business Hub | Opp. SMS Multispeciality Hospital | Visat-Gandhinagar Highway | Mot
BOTTOM | End Of Registration Form
 INTER INTERNSHIP 2021
D ONLINE (VIRTUAL) MODE Drilling Mentor Private Limited
EDABAD, CONTACT NO. +91 9435716886 CIN: U11201GJ2015PTC082746
ate REGISTRATION FORM for each batch. A group of students can use single Website : www.drillingmentor.com
separately through PayUmoney link available in BROCHURE/NOTIFICATION E-mail : info@drillingmentor.com
yment ID with date before filling registration form.

BATCH 2
Program Code & Title: WI21_B2P2_ WELL CONTROL EQUIPMENT, PRINCIPLES AND PROCEDURES
(Please copy the program Code & Title and paste in column no.3)
Last date for registrLast date for registration: 31.10.2021, 11.59 PM, ation: 31.10.2021, 11.59 PM,
Program start date: 15.11.2021

BATCH 4
Program Code & Title: WI21_B4P2_WELL CONTROL EQUIPMENT, PRINCIPLES AND PROCEDURES FOR SURFACE BOP STACKS
(Please copy the program Code & Title and paste in column no.3)
Last date for registration: 31.10.2021, 11.59 PM,
Program start date: 01.12..2021
e Registration Form. Particulars in yellow boxes have been filled up for sample only. Please replace them by your own particulars. Please donot
t will remain in Excel only. Registration Form requires no signature and photograph. Column of particulars starts from 1 and ends at 11. All entries

c shall be applied in separate Registration Forms (Use separate registration form for each program).

t banking account for trouble free remittence. The least preffered option is netbanking(NEFT/IMPS/ direct deposit to “Drilling Mentor Pvt. Ltd.”
mentioned below .

886 before and after deposting fee.

7 8
GOVT PHOTO ID NAME & NUMBER
(AADHAR/ ELECTION CARD/ PASSPORT/
DRIVING LICENCE ANY ONE)
* Please bring GOVT PHOTO ID in original at
time of joining the program
PATENT'S / GUARDIAN'S NAME & ADDRESS
9 10 11 END
FEE PAYMENT COLUMN AMOUNT REMITTED REMARKS
PAYUMONEY PAYMENT ID WITH DATE (INR) REGISTRATION STATUS (INDIVIDUAL/
OR NETBANKING DETAILS (BANK GROUP)
NAME / A/C NO./ TRANSACTION GROUP LEADER NAME
TYPE/ TRANSACTION NO. /DATE)

AADHAR & No. R K GOPHANEH PAYU PAYMENT ID: 20000 INDIVIDUAL

9465 7471 7290 AT-KOSKARWADI, POST- 12724034465 PAID ON DATE N/A
BHALAWANI, TALUKA- 15 SEPTEMBER 2021
PANDHAKAPUR, DIST-SOLAPUR,
MAHARASHTRA 413305
count of “Drilling Mentor Pvt. Ltd.” vide A/c No.: 0067 0500 5419, Account Type: Current Account, Bank Name: ICICI Bank, Ahmedabad, IFSC :

ession without any refund.

time or time as determined by the mentor.
olation of smoking & drug abuse and law & order of the place of the internship are all at own risk and responsibility of the applicant/trainee and
for educational institutions and public place failing which his/her candidature shall be cancelled and will be debarred from the running session
ease consider my application for registration. This is an email content, may be considered as a token of my acceptance.''

ltispeciality Hospital | Visat-Gandhinagar Highway | Motera I Ahmedabad- 380005 | Gujarat

Registration Form
OFFLINE,VIRTUAL