Full Name *

Email ID *

Payment ID *

Date of Birth *

Gender *
MaleFemale

Mobile Number *

District/UT of *

State/UT of *

If required I can provide ID (choose maximum options) *
PANAadhaarDriving License

Highest Education *
Graduate BSc., BCom, B.A., BBA, B.Tech etc.Post GraduationOthers

If others please specify *

Highest Education Stream *
ArtsScienceCommerceManagementTechnology

Highest Education Completion Year in (YYYY) *

Highest Education - Marks obtained / Percentage / CGPA ( if CGPA, indicate max CGPA also) *

Name of the Last Institute/College/University Attended *

Number of Months of Work Experience *
ZERO1 to 6 Months7 to 12 Months13 to 24 MonthsMore than 24 Months

Last Employer's Name (If no work experience, please mention "Not Applicable") *

Last Gross Monthly Salary Drawn (in Rs.) *
less than 1500015000 to 2000020000 to 3000030000 to 50000more than 50000Not Applicable

How did you come to know about BFSI SSC *
by using Google Search Enginegot reference from other website that I had visitedgot reference from a linkedin connect/article/postgot reference from friend / colleaguegot reference from my professor/lecturer /mentor/trainerOther

Mention the Ref CODE if any on the flyer / communication received by you

The above information furnished by me is true in all respects. If required I will submit document copies of educational qualifications, proof of ID, work experience etc. I agree to abide by all the rules and regulations of course requirements. I also understand that my application/ enrollment is liable for rejection if any false declaration is found any time at a later date . Fees once paid is not refundable under any circumstances. *
I agree / accept to enroll for the Bancassurance Channel Manager Certification Program.