Lean and Six Sigma Public Programs

Registration Form

Training Registration Form

Registration for:

Location/City:
Program Dates:
Full Name: (to be in the certificate
limit to max 16 characters)
Nomination Type
(Company Sponsored / Individual):
Gender:
Age:
Nationality:
Country of Residence & Employment
Designation:
Organization:

Industry sector: (e.g., IT, BPO,

Banking, Manufacturing etc.,):

Functional / Technical expertise (e.g,

Java, Quality, HR, Sales etc.,):

Six Sigma Green Belt Certification Program

Lean and Six Sigma Public Programs

Registration Form

Academic qualifications:
Industry experience (years):

Address (Office):

Address (Home):
Telephone (Office with Ext #):
Telephone (Res):
Mobile:
E-mail (Official):
E-mail/Chat id (Personal):

Will you carry a laptop (Y/N)?

Previous exposure to Six Sigma/Lean

(if any): (Y/N - details):

Key Expectations (Why enrolling for this program?):

Fee Payment Instructions

Program fee can be paid by cheque/DD or Online fund transfer

Lean and Six Sigma Public Programs

Registration Form

favouring "eXample India"

See Payment Instructions section below for details

Payment detailsAmount (Currency/Value):

Paid by : (Cheque/DD/Online
Transfer)
Bank Name:
Bank Branch:
City:
Cheque/DD/E-Instruction date:
Cheque/DD/E-Instruction No.:
Funds Credited/Transferred to:

(Please fill the above form completely and e-mail to sixsigma@examplecg.com

to register for the program). For payment instructions, read on

Lean and Six Sigma Public Programs

Registration Form

What Next?
On receipt of the application, an acknowledgement E-mail shall be
sent to you.
On receipt and realization of the program fee (by Cheque/DD/Online
transfer), the nomination shall be confirmed.
A program invite with complete details (Venue, contact person and
detailed instructions) shall be communicated shortly thereafter.
Payment Instructions
Payment cane done via:
1. Electronic Fund transfer (NEFT) into our Bank A/c details given below)
This is recommended payment option, fast, safe, accurate and reliable
Bank Account details to be used for Electronic Fund transfer (NEFT)
Our HDFC Bank A/c

Beneficiary Name
Beneficiary Account Type:

: eXample India
: Current Account

Beneficiary Current A/c No

: 00092320005802

Beneficiary Bank

: HDFC Bank

Bank Branch

: Kasturba Rd, Bangalore 560 001

IFSC Code

: HDFC0000009

2. Cheque Favouring eXample India.

Deposit cheque at the nearest HDFC Bank Counter or ATM Drop box. (For
cheques drawn on a bank/branch outside the six metro cities, please add
INR 150 towards outstation charges)

To deposit cheque in HDFC Bank, fill up the pay-in slip (or) challan with our
a/c details given below.

Beneficiary
: example India
Current A/c No : 00092320005802

Lean and Six Sigma Public Programs

Registration Form

Branch

: Kasturba Road, Bangalore 560 001

Deposited By

: <Your Full Name> and <Mobile #>

Cheques are accepted only till 7 days before program start date

3. Demand Draft (DD) favouring eXample India. DD should be made payable

in Bangalore. Fill in a pay-in slip / challan with our account details (given in
section 2 above) and deposit DD to nearest HDFC Bank counter or ATM
Drop box (or) post / courier DD to our mailing address.

4. By CREDIT CARD (using Dial-a-Draft facility)

Call your Banks Credit Card phone banking # and place a Dial-a-draft
request favouring eXample India payable at Bangalore using your Credit
card. Obtain DD and send to our mailing address.
5. Non-resident Indians (NRIs) and International candidates can also remit
fees via channels given below.
a. Visit www.eventbrite.com, use keyword Six Sigma to get our program
details, choose the right ticket category, select quantity (i.e., no. of
participants) and pay via Creditcard (Master/Visa/Paypal)
b. Use www.remit2india.com (or) www.xoom.com (or)
www.westernunion.com to transfer funds favouring eXample India
and credit funds directly into our Bank A/c (Details in Section B1 above)

DO NOT deposit Cash or registration form into Drop box

For HDFC Bank Branches in your city

Visit http://www.hdfcbank.com/applications/locator/branch.asp, select the,
Press <Ctrl F>, type in your locality name and get the address of the HDFC
Branch in or around your work place / residence
For HDFC Bank ATMs Drop boxes in your city

Lean and Six Sigma Public Programs

Registration Form
Visit http://www.hdfcbank.com/applications/locator/atm.asp, select the city,
Press <Ctrl F>, type in your locality name and get the address of HDFC ATM
Drop box in or around your work place / residence

EXAMPLE INDIA - MAILING ADDRESS

Bangalore
Mr. Sethu V
eXample India
3A, Abhijit Annexe
11th Cross, 8th Main,
Malleswaram,
Bangalore 560 003
T: +91-80-4128 1482
M: +91-99862 73363

Mumbai
Mr. Ramamoorthy K
eXample India
B 504, Vasukamal
Saki Vihar Rd
Andheri East,
Mumbai 400 072
T : +91-22-4015 9748
M : +91-98201 58537

Chennai
Mr. Sethu V
eXample India
Old # 18, New # 10,
Meenakshi Street,
Perambur,
Chennai 600 011
T: +91-80-4128 1482
M: +91-92824 30968

E: sixsigma@examplecg.com
W : www.examplecg.com
Chat online with us at
examplecg
(@yahoo.com / @hotmail.com / @gmail.com / @rediffmail.com / @aol.in)
Skype: examplecg
End of Document