To,

The Director
All India Institute of Ayurveda
Mathura Road, Gautampuri, Sarita Vihar
New Delhi - 110076
Sub: Application for attending CME on Integrative Oncology reg.
Madam,

I hereby submit my application to participate in CME being organized b y your institute in the subject Of
Integrative Oncology. My bio-data is as follows-
Full Name (in BLOCK letters): jhjhbsdhj sdfjbjhdsf

Father's Name: fsdvdsg

Date of Birth: 2024-01-09 Age:

45 Gender:
Male

Educational Qualification:

Name Of Degree

Masters

Regstration No.: dsfdsg Teachers Code:

sdgsg

Designation: sdgsdgsdg Department:

Demo Department

Name Of Institute: gsdgsdg

Experience: gsdgsg Years:

3 Months:
2

Have you practicing/running clinic/unit in cancer care: Yes

Have you participated in ROTP/ CME earlier: No

Full address for correspondence with Pin Code:

safds

Office:
sdfsdf

Mobile Number: 8236487632

 E-mail ID: faculty2222@gmail.com

Water ID Card: 23532563632626

Bank Details:

Name Of The Bank: sdgsdg Branch:

dsgsdg

Account No.: 3525235235 IFSC Code:

wf235325

The information furnished above is true and correct as per the best of my knowledge and I accept full
responsibility for the same. I shall abide the Instruction given by the organizer for smooth conduction of
Programme.
Date: Signature Of applicant

Recommendation of the Head of the Institute: Signature of the Head of the Institute with seal

(Note: If the information given above is incomplete in any respect, the form will not be considered)