Application Form for the RBI/IBA approved course

Certified Information Security Professional (CISP)

Application No:
Affix your recent
(To be filled by GFSU) passport size
photograph

First Name:
(To be filled in Capital Letters)

Last Name: Date of Birth: / / (dd/mm/yy)

(To be filled in Capital Letters)

Contact No: Alternate Contact No:

Email :
(To be filled in Capital Letters)

Address: City:

State: Pincode:

Educational Qualification:

Current Organization Name:

Designation: Professional Experience: yr months

Domains Expertised:

Interested Domain:
Organization contact details & Address:

Details of certifications done so far (If any):

Details of previous worked organizations with experience (If any):

Payment details:
Payment Mode Cheque /DD /UTR Number Date of Issue/Transaction Issuing Bank

I. Fee details:
The Fee structure for an individual candidate is:
Application fee (Non refundable) : Rs. 1,200
Course fee includes both On-line and Lab exposure : Rs.40,800
Examination Fee for certification : Rs. 8,000

Total (in INR) : 50,000/-

II. Procedure to register:

➢ Application fee of 1200/- should be paid for registration to the course and this amount can be paid
either through Online/Demand Draft/Cheque.
➢ The Cheque & Demand Draft should be drawn in the favor of REGISTRAR, GUJARAT FORENSIC
SCIENCES UNIVERSITY, GANDHINAGAR, GUJARAT
➢ Account details for online payment:

Name of the account GUJARAT FORENSIC SCIENCES UNIVERSITY

Bank Name PUNJAB NATIONAL BANK

IFSC Code PUNB0460100

Bank Account Number 4601002100000082

Branch Address JALSEVA BHAVAN BRANCH, SECTOR - 10,GANDHINAGAR,

GUJARAT

➢ The application form and payment proof/Cheque/DD should reach on or before 25/12/2017 to
Gujarat Forensic Sciences University,Sector 9,Gandhinagar-382007,Gujarat – India.
➢ The remaining fee of 48,800/- INR should be paid upon the acceptance of the application.

Please make sure the following to be attached with the application:

1. Photo copy of 10th standard Mark Memo.
2. Photo copy of Graduation Mark Memo.
3. Photo copy of Post Graduation (If done) Mark Memo.
4. Cheque / DD of fee payment.
5. Photo copy of address proof (Government of India approved).

Declaration:
I here by declare that, the above mentioned details are correct to the best of my knowledge.

Candidate’s Signature