Indian Statistical Institute, SQC & OR Unit, Bangalore

CERTIFICATION PROGRAM for SIX SIGMA BLACK BELT (BB-21)

18 23 January, 22 27 February; 2016

Registration Form
Organization

Contact Person

Mailing Address :

E-mail

Phone/Mobile:

Details of the participants attending the program:

e-mail & Mobile

Participant Name

Total Amount

1
2
3
4
A. Sub Total of above
B. ADD: Service tax @ 14%
C. Total Amount Payable

(14% of (A) ):
(A+ B) :

Payment Details: Amount :Rs.

DD/Transaction No.:

Date:___/___/_____,

Bank/Branch:

1. Registration forms will not be accepted without course fee.

2. No request for refund of the course fee (fully or partially) will be
entertained after commencement of the program.
Signature :
____________________

Name:
Date: :___/___/____
________________________________
_____
_

Send completed form with fees and attachments to :

Dr. E.V. Gijo/ Prof. P.K.Perumallu

Program Director: BB-21
SQC & OR Unit
Indian Statistical Institute
th
8 Mile, Mysore Road
Bangalore 560 059, INDIA.

E-mail: gijoev@gmail.com, kesperp@gmail.com

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Terms and Conditions

1. The course duration: 12 days
a. Phase -1 : 18 23 January, 2016
b. Phase -2 : 22 27 February, 2016
2. 100% attendance is mandatory
3. Eligibility criteria for applying for the course: Degree/Diploma in any discipline with
Six Sigma Green Belt certification.
4. Course fee per person: Rs.60,000/- + Service Tax of 14% (Rs. 68,400/-)
5. Accommodation in twin-sharing basis can be availed as a first-come-first-served basis
for the participants at the ISI guest house on extra payment basis. For
accommodation in guest house, please contact tiwari@isibang.ac.in (+91 98454 84356)
6. Online fund transfer details
a. Name
: Indian Statistical Institute
b. Bank
: UCO Bank, Kengeri Branch, Mysore Road, Bangalore
c. Account No.
: 02970200000702
d. IFSC code
: UCBA0000297
e. Type of Account: Current Account
7. Income Tax Permanent A/c No.
: AAAAI 0345 R
Service Tax Registration No.
: S&T/B-III/Kengeri Dn./2/ISI/2001S.T.
Category
: Scientific & Technical Consultancy Services
Service Tax RC Code
: STC/AAAA I 0345RST003
8. No refund of course fee will be entertained after commencement of the program.
9. Participation is confirmed after receipt of
a. Filled in application form
b. Copies of certificates for proof of eligibility
c. Course fee in full (DD or online transfer)
10.ISI will provide a receipt for the payment received after the start of the course. The
same to be used as a proof of payment. ISI accounting system does not entertain any
other form of documentation.
11. A participant will be declared as certified Black Belt only after
a. Passing the BB certification test with minimum 70% marks.
b. A completed Six Sigma project report (in ppt) to be submitted to the course
directors after 4 months but not later than 1 year after the last date of the
course.
c. The submitted project report will be evaluated for suitability.
A candidate will be issued a Black Belt certificate only after adhering to 11(a), 11(b)
and 11(c).
12. If the project report is not received within one year from the end of the course, the
participant automatically losses the entitlement to receive a certificate.
13. All participants qualifying the exam (refer 11(a)) will receive an attendance certificate.
14. Any candidate failing to qualify the exam will be given another chance for writing the
test along with the next program participants.
15. Failed candidate (refer 11(a)) will not be issued any certificate.
16. Any participant applied for the program is understood to have gone through and
accepted these terms and conditions.

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