JCI INDIA FUTURE

Mail to: JCI INDIA, National Headquarter, 506 Windfall, Sahar Plaza, J.B. Nagar, Near Chakala Metro
Station Andheri (E), Mumbai-400 059, Ph: 022-71117112.. E-mail: training@jciindia.in

Name of LOM Zone

Name of Institution
Number of Participants Students degree (Academic)

Dates (events) From To

S. Duratio Subject Name of Signature of

No. n Trainer Trainer

Comments from the Head of the Institution

Signature of LOM President

Signature of Head of Institution
1. List of participants certified by the head of the institution should be attached.
2. Please send this format duly filled to NHQ along with action photographs of the program and list of participants.
Deadline is 15th August, 2024
3. Action Photograph must include the audience with the trainer and chapter’s banner.