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REGISTRATION FORM
NAME *
DATE OF BIRTH
MM
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DD
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YYYY
SUPERVISOR/MENTOR:
DEPARTMENT
INSTITUTION *
COMPLETE POSTAL ADDRESS
EMAIL ID *
CONTACT DETAILS *
ICCS MEMBER *
REGISTRATION TYPE *
Registration fees Payment by NEFT/RTGS
Payment should be made in the favor of :Institute of Chemical Technology
Bank Name: Bank of Maharashtra;
Account No: 20019464929;
MICR Code: 400014051;
SWIFT Code: MAHBINBBLJR;
IFSC Code: MAHB0000339
Amount *
Date of Transaction *
MM
/
DD
/
YYYY
Bank Name *
UTR Number *
Transaction No./ ID *
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