APPLICATION FORM

APPLICATION FORM

Name:

Address:

Telephone:

Off:

Res:

Fax:

E-Mail Address:

Marital Status:

Single

Married

Educational Qualifications:

Diploma

Graduate

Post Graduate

Specialization:

Others:

Your Training / Proficiency / Experience

Typing:

Nil

General

Professional

Words Per Min:

Computers:

Medical:

English:

Work Experience:

Any other qualifications / skills that you think may be useful in the course:

Why do you want to do this course:

Payment:

Down - Rs. 13,500

Installments - Rs. 5,000 X 3