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1. Name.
:
.
(In block letters)
2. Full Address: (Present)
(Including phone numbers and pin code)
Permanent
:
......
3. (A) Email Address:
(b) Website:
4. Age (Place & Date of Birth)
5. a) Nationality
b) Passport No.
..
. Valid up to
c)
Expected arrival date in the United
Kingdom.
..
6. Sex
7. Occupation
8.
Homoeopathic experience
..
..
(Please state in detail, if necessary attach separate
sheet)
9. In case of any emergency abroad, please state
the name, address &
telephone number of whom to notify:
10. Amount enclosed (Advance deposit/Entire Programme
Fees)
(a) Balance due
I
solemnly undertake to abide by the rules and regulation of the management
of
the College and maintain the peace and discipline of the College, failing
which
the management has the right to strike out my name from the Register for
which
no proceedings can be undertaken in any court of law.
Place
..
Date
.
______________________________
Signature
of the applicant in full
* Photocopies of credentials, two passport
photographs are to be enclosed.
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(Affix one passport photo here)
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