NATIONAL INSTITUTE OF SECURITIES MARKETS

An Educational Initiative by SEBI

Certificate in Securities Law

2013

Affix Passport size photograph here

APPLICATION FORM
PERSONAL PROFILE
First Name:

Middle Name:

Last Name:

Gender: Male

Female Single Age: Nationality:

Marital Status: Married Date of Birth (DD/MM/YYYY): Occupation: Address for Communication:

Residence Tel. No.: Office Tel. No.: Fax No.: Mobile No.: Email:

Permanent Address (If different from address for communication):

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EDUCATIONAL QUALIFICATION
Name of Degree: Name of the University: Year of Passing:

ACADEMIC PROFILE
Exam Name of the Exam / Subjects Month & Year Name of School % of of passing / college Marks obtained Name of the Board / University

SSC HSC Graduation (Specify)

B.Com, B.B.A., Others

Post Graduation Others

WORK EXPERIENCE DETAILS

Total Work Experience: Organization Years : Months: Till Designation Nature of Duties

From

PAYMENT DETAILS
Amount: `500/DD / Pay Order No.: Banks Name and Branch: Date (DD/MM/YYYY):

I agree to abide by NISMs rules, code of conduct and students guidelines framed/to be framed from time to time. I hereby certify that the above information given is true and correct to the best of my knowledge. I understand that any false declaration shall result in disqualification of my admission to CSL.

Applicants Signature: Place: Date:

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