Lean and Six Sigma – Public Programs

Registration Form

Training Registration Form

Registration for: Six Sigma Green Belt -

Certification Program

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.,):
 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 details-
Amount (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 : eXample India

 Beneficiary Account Type: : 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 Bank’s 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 Mumbai Chennai

Mr. Sethu V Mr. Ramamoorthy K Mr. Sethu V

eXample India eXample India eXample India
3A, Abhijit Annexe B 504, Vasukamal Old # 18, New # 10,
11th Cross, 8th Main, Saki Vihar Rd Meenakshi Street,
Malleswaram, Andheri East, Perambur,
Bangalore 560 003 Mumbai 400 072 Chennai 600 011
T: +91-80-4128 1482 T : +91-22-4015 9748 T: +91-80-4128 1482
M: +91-99862 73363 M : +91-98201 58537 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