national stock exchange's certification in financial markets (ncfm)

NATIONAL STOCK EXCHANGE'S CERTIFICATION IN FINANCIAL MARKETS (NCFM) REGISTRATION FORM (Please read instructions on page 2 carefully before filling up the form) FIRST NAME MIDDLE NAME SURNAME PART-I (In case you are already registered, please ignore Part I and fill-up Part II and III) NAME TO BE PRINTED ON CERTIFICATE DATE OF BIRTH (DD-MMM-YYYY) MALE/FEMALE - - ADDRESS FLAT NO/ H.NAME & NO. STREET NAME : VILLAGE/AREA/DIS TRICT : LANDMARK : STATE : __ ____________ ___ (Cand idates Signat ure- Sign inside the b ox) CITY PINCODE RESIDENCE/MOBILE NO: (WITH STD CODE) OFFICE NUMBER (WITH STD CODE) E MAIL - (MANDATORY) QUALIFICATIONS PROFILE COURSE YR OF PASSING UNIVERSITY / INSTITUTE % / GRADE PART-II TEST DETAILS NCFM-_____________________________ (specify registration number, if already registered under NCFM.) MODULE NAME (Select the desired Module) For Office Use only Financial Markets: A Beginners' Module AMFI-Mutual Fund (Basic) Module Hand Del/ Courier Mutual Funds : A Beginners' Module Mails of the Day Securities Market (Basic) Module AMFI-Mutual Fund (Advisors) Module Chkd/Reg./Scanned Capital Market (Dealers) Module English Gujarati Hindi Enrollment/DD Entry English Gujarati Hindi Surveillance in Stock Exchanges Module SM Issued/SM Sent Corporate Governance Module Derivatives Market (Dealers) Module Compliance Officers (Brokers) Module English Gujarati Hindi Compliance Officers (Corporates) Module Information Security Auditors Module (Part-I) FIMMDA-NSE Debt Mark et (Ba sic ) Module Inf ormati on Sec uri ty Aud itors Mod ule (Pa rt- II) NSDL - Deposi tory Ope rat ions Mod ul e Opt io ns Tr ading St ra te gi es Module Commodities Market Module Note: Test in Capital Market (Dealers) Module, Derivatives Market (Dealers) Module and AMF I - Mutual Fund (Adv) Module are available in Engl ish, Gujarati and Hindi languages. Please tick the appropriate language. TEST SCHEDULE TEST CENTRE TEST DATE TEST TIME - - : D D M M M Y Y Y Y H H M M Once the test details has been specified by the candidate, the test cannot be rescheduled Fees once paid shall not be refunded. Test fees are valid for six months from the date of payment. Candidates need to enroll for the test(s) within six months from payment of fees. PART-III PAYMENT DETAILS DD NUMBER 1 DD NUMBER 2 DD NUMBER 3 DD DATE ( DD-MM-YY) TOTAL DD AMOUNT - - ISSUING BANK (NAME AND BRANCH) I certify that the above information provided by me is true and correct to the best of my knowledge, information and belief. PLACE DATE - - 2 0 0 (CANDIDATE'S SIGNATURE) Recent Passport size Colour Photograph

national stock exchange's certification in financial markets (ncfm)

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