REGISTRATION FORM

INDIAN INSTITUTE OF CAPITAL MARKETS

Professional Development programme on

“Finance for Non-Finance Executives” We nominate the following participant to attend the Program:

Name of the participant: ______________________________________________________________

Designation : _______________________________________________________________________ Organisation : _______________________________________________________________________

Address: ____________________________________________________________________________ ____________________________________________________________ Pincode:________________ Telephone:______________________________________ Fax No:____________________________ Mobile No.: __________________________ Email: ________________________________________ Cheque/DD. No_____________ dated _______________ for R _________________ drawn on

___________________________ in favour of “Indian Institute of Capital Markets” is enclosed.

Signature & Stamp of the Nominating Authority: ________________________________________

Programme Fees: R 20,000/-* (all inclusive) per participant on Non-residential basis *Fees include participation’s course material, books (if any), lunch and tea/coffee. Programme Dates: (Tick the appropriate Box)

SN Dates Tick SN Dates Tick

1 August 27 – 31, 2012 4 February 11 – 15, 2013

2 October 29 – November 2, 2012

5 April 15 – 19, 2013

3 December 10 – 14, 2012

Registration form alongwith Cheque /DD to be send at the following address:

Indian Institute of Capital Markets (UTI Institute of Capital Markets)

2nd Floor Hindavi Bhavan, Plot No. 13, Sector 1 Vashi, Navi Mumbai – 400 703

Tel No.: 022-2782 0114/15 Telefax: 022-2782 0153/54 Email: pdp@utiicm.com, info@utiicm.com

Website: www.utiicm.com