Please affix your recent passport size photo Jamnagar Branch of WIRC of ICAI 305, 306, 313 & 314, Mayur Complex, Khdiyar Colony, Jamnagar – 361006. Tele Fax 0288 – 2713333 email [email protected] Issued Receipt No. 100 Hrs. Advance I. T. Training REGISTRATION FORM Name of the student :- _______________________________________ Registration No :- _______________________________________ (Enclose the photocopy of Articleship Registration letter) Final Exam appear on :- _______________________________________ Communication Address :- _______________________________________ _______________________________________ City :- _______________________________________ Contact No. :- R)_____________________________________ M)_____________________________________ E-mail ID :- _______________________________________ Payment by Cheque/DD :- Ch No._____________ Dated ______________ Bank Name _________________ of Rs. 5000/- Ch./DD in Favour of :- “Information Technology Centre, Jamnagar Branch, ICAI” Payable at Jamnagar. I hereby declare that the above statements furnished are true and fair to the best of my knowledge. ___________________ Signature of the Student NOTE 1. Application for refund will not be entertained 2. Branch Managing Committee reserves all the right to alter timings, cancel and change the student’s registration etc. Recommendation of Members Mr./ Ms.____________________________________ is serving under me as an Articled Assistant w.e.f. ________________and is duly registered with ICAI with above Registration No. I hereby allowed him/her to join Adv. ITT Course at Jamnagar. Date Name of Member Membership No. Signature of Member (with Seal)