Excel - 3P PROGRAMME

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					                                              3P PROGRAMME A Registered Firm
                                           (Please read instructions carefully before filling up the form)
                                                                   Page1
                                                      REGISTRATION FORM

                   Dr.             Mr.                      Ms.                Mrs.
FIRST NAME                                                               MIDDLE NAME

LAST NAME                                                                BRANCH CODE            BRANCH NAME



                                                            Personal Details
DATE OF BIRTH (DD-MM-YYYY)             MALE/FEMALE
       -          -
ADDRESS (CORRESPONDANCE)                                                                                      Recent
                                                                                                           Passport size
ADDRESS LINE 1:
                                                                                                         Colour Photograph
ADDRESS LINE 2:
ADDRESS LINE 3:
ADDRESS LINE 4:
STATE : ________________________________________________________

CITY                                                  PINCODE

MOBILE NUMBER                                                  INCOME(Annual)                   (Candidates Signature- Sign inside the box)
+ 9 1                                                          Rs.
E MAIL - (MANDATORY)



QUALIFICATION DETAILS              Below Higher Secondary            Higher Sec / Technical Diploma          Graduate         Post Graduate

BELOW HIGHER SECONDARY ONLY                           Yes                No
HIGHER SECONDARY / TECHNICAL DIPLOMA
MAJOR SUBJECT      YR OF PASSING                                     UNIVERSITY / INSTITUTE                                       % / GRADE/CGPA
                                                                                                                                     .
GRADUATION DETAILS
MAJOR SUBJECT      YR OF PASSING                                     UNIVERSITY / INSTITUTE                                       % / GRADE/CGPA
                                                                                                                                     .
POST-GRADUATION DETAILS
MAJOR SUBJECT      YR OF PASSING                                     UNIVERSITY / INSTITUTE                                       % / GRADE/CGPA
                                                                                                                                     .

OCCUPATIONAL DETAILS
   Student     Govt. Employee      Private Employee            Business Man       Agriculture Man       Others(pls specify)

IF EMPLOYED, KINDLY PROVIDE CURRENT EMPLOYMENT DETAILS:
NAME OF THE ORGANISATION

DESIGNATION                                                                                                     -        -
ADDRESS OF THE ORGANISATION                                                                                  FROM DATE (DD-MM-YYYY)




CITY                                         PINCODE                           TELEPHONE NO. (WITH STD CODE)



FAX NO. (WITH STD CODE)
                                                3P PROGRAMME A Registered Firm                                         Reference ID(If have Only
                                       (Please read instructions carefully before filling up the form)
                                                                       Page 2
                                                          COURSE SELECTION FORM

                         NCFM-                                                  (Registration number, if already registered under NCFM)

                         PREFERRED LOCATION(for exam)

                         Note: All the Training Classes are available in English cum Hindi Only
Tick √ or ×                                   For Fundamental Investment Education 'Combo Offer'                                    Code:      1   0   1

Fundamental Course                                                                                                        For Office Use Only
   Financial Markets: A Beginners' Module                                                                             Reference ID
   Commercial Banking in India: A Beginner's Module                                                                   DD/Chq./Bank Entry
   Mutual Funds : A Beginners' Module                                                                                 S.E.E.Code Issued/Sent


Tick √ or ×                                                         For Individual Module                                           Code:      2 …. ….

NCFM CERTIFICATION                                                                            NCFM CERTIFICATION
  Financial Markets: A Beginners' Module          0             1                               FIMMDA-NSE Debt Market (Basic) Module              0   8
  Commercial Banking in India: A Beginner's Module0             2                               Capital Market (Dealers) Module                    0   9
  Mutual Funds : A Beginners' Module              0             3                               Derivatives Market (Dealers) Module                1   0
  Currency Derivatives: A Beginner's Module       0             4                               Options Trading Strategies Module                  1   1
  Equity Derivatives: A Beginner's Module         0             5                               Commodities Market Module                          1   2
  Interest Rate Derivatives: A Beginner's Module  0             6                               NSDL- Depository Operations Module                 1   3
  Securities Market (Basic) Module                0             7                               Investment Analysis and Portfolio Management       1   4

NISM CERTIFICATION                                                                                          5   0
   Currency Derivatives Certification Examination                                                           5   1
   Mutual Fund Distributors Certification Examination                                                       5   2
   Interest Rate Derivatives Certification Examination                                                      5   3
   Registrars to an Issue and Share Transfer Agents – Mutual Fund Certification Examination                 5   4

Tick √ or ×                                                         For Live Market Course                                          Code:      3 …. ….
   CAPITAL MARKET                                           0   1                                COMMODITY MARKET                                0 3
   DERIVATIVE MARKET                                        0   2                                CURRENCY MARKET                                 0 4

Tick √ or ×                                                      For Advance Excel Course                                           Code:      4   0   1

Tick √ or ×                                              For AMFI Registration Number (ARN)                                          Code: 5 …. ….
TO GET ARN                                                                                       TO RENEW ARN
   CORPORATE ONLY    BANK/ NBFCs/ Institutional Distributors                         0    1         CORPORATE ONLY
                     PUBLIC LIMITED COMPANY                                          0    2            Banks/NBFC/Institutional Dist         5 0
                     PRIVATE LIMITED COMPANY                                         0    3            Public Ltd. Co                        5 1
                     PARTNERSHIP FIRM                                                0    4            Pvt. Ltd. Co.                         5 2
                     SOCIETIES AND TRUST/ HUF                                        0    5            Partnership Firm                      5 3
                     POST OFFICE                                                     0    6            Societies and Trust / HUF             5 4
                     PROPRIETORSHIP FIRM                                             0    7            Post Offices                          5 5
    CORPORATE EMPLOYEE                                       0                       8                 Proprietorship Firm                   5 6
    INDIVIDUAL       SENIOR CITIZENS CATEGORY                                        0    9         INDIVIDUAL/CORPORATE EMPLOYEE5 7
                     OTHERS                                                          1    0
Fees once paid shall not be refunded. Guidance fees are valid for 180 days from the date of payment.
                                                                        Payment Details
DD/CHEQUE/BANK CASH DEPOSIT ID NUMBER                                             DATE ( DD-MM-YYYY)           AMOUNT(INR)
                                                                                      -          -
ISSUING BANK NAME AND BRANCH NAME                           ……………………………………………………………………………………………
I read all instructions provided by 3P PROGRAMME carefully and understand it properly.
I certify that the above information provided by me are true and correct to the best of my knowledge.
PLACE                                                               DATE              -          -
                                                                                                      (CANDIDATE'S SIGNATURE)

				
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posted:9/14/2011
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