NATIONAL STOCK EXCHANGE'S CERTIFICATION IN FINANCIAL MARKETS (NCFM)

REGISTRATION FORM
(Please read instructions on page 2 carefully before filling up the form)
FIRST NAME MIDDLE NAME

SURNAME

PART-I (In case you are already registered, please ignore Part I and fill-up Part II and III)
NAME TO BE PRINTED ON CERTIFICATE

Recent
Passport size
DATE OF BIRTH (DD-MMM-YYYY) MALE/FEMALE Colour Photograph
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ADDRESS
FLAT NO/ H.NAME & NO.__________________________________________
STREET NAME : _________________________________________________
VILLAGE/AREA/DISTRICT : ________________________________________
LANDMARK : ____________________________________________________
STATE : ______________________________________________________ (Candidates Signature- Sign inside the box)
CITY PINCODE RESIDENCE/MOBILE NO: (WITH STD CODE)

OFFICE NUMBER (WITH STD CODE) E MAIL - (MANDATORY)

QUALIFICATIONS
PROFILE
YEAR OF PERCENT /
COURSE UNIVERSITY / INSTITUTE
PASSING GRADE

PART-II TEST DETAILS

NCFM-_____________________________ (specify registration number, if already registered under NCFM.)

MODULE NAME (Select the desired Module)

Capital Market (Dealers) Module NSDL Depository Operations Module For Office Use only
Derivatives Market (Dealers) Module in: Commodities Market Module ? Hand Del/ Courier
English language AMFI-Mutual Fund (Advisors) Module ? Mails of the Day
Gujarati language AMFI-Mutual Fund (Basic) Module ? Chkd/Reg./Scanned
? Enrollment/DD Entry
Hindi language Corporate Governance Module
? SM Issued/SM Sent
Securities Market (Basic) Module Compliance Officers (Brokers) Module
Surveillance in Stock Exchanges Compliance Officers (Corporates) Module
FIMMDA-NSE Debt Market Module Information Security Auditors Module (Part-I)
Financial Markets: A Beginners' Module Information Security Auditors Module (Part-II)

Note: Test in Derivatives Market (Dealers) Module is available in English, Gujarati and Hindi languages.
Please tick the appropriate language.

TEST SCHEDULE
TEST CENTRE TEST DATE TEST TIME
- - :
D D M M M Y Y Y Y H H M M
Once the test details has been specified by the candidate, the test cannot be rescheduled
Fees once paid shall not be refunded.

PART-III PAYMENT DETAILS

DD NUMBER 1 DD NUMBER 2 DD NUMBER 3 DD DATE ( DD-MM-YY) TOTAL DD AMOUNT
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ISSUING BANK (NAME AND BRANCH)

I certify that the above information provided by me is true and correct to the best of my knowledge, information and belief.
PLACE

DATE - - 2 0 0
(CANDIDATE'S SIGNATURE)