REGISTRATION FORM FOR VSKILL CERTIFICATIONS

V Skills
Skills for a secure future

REGISTRATION FORM
(Please read instructions carefully before filling up the form)

1. FIRST NAME
2. FATHER'S NAME

LAST NAME

PART-I PERSONAL DETAILS

3. DATE OF BIRTH D D M M Y Y Y Y 4. MALE/FEMALE (M/F)

5. ADDRESS

6. CITY

7. PIN CODE (Mandatory)

8. RESIDENCE / MOBILE NO. (WITH STD CODE)

9. OFFICE NO. (WITH STD CODE)

10. E-MAIL (Mandatory)

PART-II TEST DETAILS

11. Vskills Centre Code
12. VSKILLS ROLL NO. 13. CERTIFICATION APPLIED FOR (Please mention the certification Code & Name)
(Mention Vskills Test Centre Code)

Test Date
D D M M Y Y Y Y

(Previous Roll No. if, re-appearing)

VS Code Name of Certification

PART-III PAYMENT DETAILS

Draft/P.O./Cheque/Cash in the name of "Intelligent Communication Systems India Limited" payable at New Delhi. Amount are different for different certifications, please confirm before hand. 14. DD/CHEQUE/PO NUMBER 15. DD/CHEQUE/PO/CASH DEPOSIT DATE
D D M M Y Y Y Y

16. TOTAL DD/CHEQUE/PO/CASH AMOUNT

17. 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. 18. DATE
D D M M Y Y Y Y

19. PLACE 20. Candidate Signature (Sign inside the box)

REGISTRATION FORM FOR VSKILL CERTIFICATIONS

V Skills
Skills for a secure future

TEST SCHEDULE ( FOR OFFICE USE ONLY )

TEST CENTRE TEST DATE
D D M M Y Y Y Y

TEST TIME
H H M M

VSKILLS ROLL NO. VSKILLS REGN. NO.

INSTRUCTIONS FOR FILLING THE FORM Please use BLACK BALLPOINT PEN to fill the form. Please fill all the details only in CAPITAL LETTERS. mention one alphabet in each BLOCK provided and leave one blank space between records. Mode of payment: 1. Mention First Name and Last Name in the given order. (a) Applicants are required to make payment by Demand Draft (DD) / Cheque/ 2. Please specify your Father 's Name PO in Indian rupee (INR). (b) DD / Cheque / PO should be drawn in the favour of Intelligent 3. Fill in your DATE OF BIRTH in the following format Communication Systems India Limited payable at New Delhi. DD-MM-YYYY (e.g. 14 05 1978). (c) Please mention at the back of the DD / Cheque / PO - Your Name, Contact 4. Please mention 'M' for Male, 'F' for Female. details, fees and mention the Certification course you wish to register 5. Please mention your complete Postal address for the purpose of examination. (d) Please check if the DD / Cheque / PO has been duly signed by bank 6. Please mention your City e.g. Jaipur authorities & it is of requisite amount. 7. Please mention your PIN CODE (e) Cash should be paid at any Axis Bank branch with following details 8. Please mention your Mobile/ Residence number (with STD Code) Bank Name - AXIS BANK Please mention your office number (with STD Code) 9. 10. Please mention your email address Branch - CHITTRANJAN PARK, NEW DELHI 11. Please specify the exam centre code and test date for which you wish to enroll. Account No. - 910020047462247 12. Please specify your previous exam roll number if, re-appearing. IFSC code - UTIB0000430 13. Please fill the correct code and name of the certification for which you wish to enroll. Post Application Form to : 14. Please mention the DD/ Cheque / Pay Order number For further information or assistance, V-Skills 15. Please mention the date of DD/Cheque/Pay Order/ Cash payment please contact Postal Collection Centre 16. Please mention the total amount being paid Vskills @ 011 - 473 44 723 or 17. Please mention the (name and branch) of the bank from which Demand E-36, Second Floor, email at info@vskills.in Main Road, Naraina Vihar Draft/ Cheque / Pay order has been issued or cash deposited. Visit us at www.vskills.in 18. Please mention the date of completion of the form Delhi -110028 19. Please mention the place where the form was filled 20. Please put your signature within the box