21st MANAGEMENT SKILLS ORIENTATION PROGRAMME [MSOP] The ICSI-SIRC is conducting its 21st MANAGEMENT SKILLS ORIENTATION PROGRAMME [MSOP] from 21st January 2015 to 7th February 2015 (25th, 26th and 1st February 2015 are holidays) at ICSI-SIRC House, 9, Wheat Crofts Road, Nungambakkam, Chennai - 600 034. The last date for registration is 19th January 2015. Batch No. Date 21st Batch of MSOP 21st January 2015 to 7th February 2015 Venue of Programme Contact ICSI–SIRC House, The Regional Director, 9, Wheat Crofts Road, Nungambakkam, The Institute of Company Secretaries of India, Southern India Regional Office, Chennai – 600 034. 9, Wheat Crofts Road, Nungambakkam, Chennai – 600 034. Phones: 044-28279898 / 28268685 Email : siro@icsi.edu The participation fee is Rs.5,000/- [Rupees Five Thousand only]. The fee does not include lunch and the outstation participants have to make their own arrangements for Stay. REGIONAL DIRECTOR ICSI – SIRO MANAGEMENT SKILLS ORIENTATION PROGRAMME APPLICATION FORM 1. NAME : 2. STUDENT REGN. NO. : 3. LICENCIATE NO. : 4. PARTICULARS OF PASSING THE PROFESSIONAL PROGRAMME / FINAL EXAMINATION: [Xerox copies should be enclosed] Exam Professional Programme – Module I / Final Group – I Professional Programme – Module II / Final Group – II Professional Programme – Module III / Final Group – III Professional Programme – Module IV Session & Year Registration / Roll Number 5. FULL MAILING ADDRESS E-Mail : : 6. IF EMPLOYED, PLEASE STATE: (a) Designation/Position : (b) Name of the Organization : (c)Address : E-Mail 7. TELEPHONE No(s). 8. DETAILS OF PRACTICAL EXPERIENCE ACQUIRED/ MANAGEMENT TRAINING/ : : MOBILE : RESIDENCE : OFFICE : : APPRENTICESHIP UNDERGONE AS PROVIDED UNDER REGULATION 48. 9. DETAILS OF PRACTICAL TRAINING : UNDERGONE UNDER REGULATION 50 10. DETAILS OF TOTAL OR PARTIAL : EXEMPTION FROM PRACTICAL TRAINING OBTAINED UNDER REGULATION 51 OR 52. 11. ACADEMIC/PROFESSIONAL : QUALIFICATIONS 12. PARTICULARS OF FEE PAID : [1] DD No.__________dated__________for Rs.5,000. [Or] [2] Cash Rules regarding refund and transfer of fee:    Fee once paid will not be refunded Fee can be transferred to the immediate subsequent session of MSOP and such request to be received before the commencement of the programme Fee once transferred to the immediate subsequent session, the same cannot be retransferred and the fee paid shall remain forfeited. 13. DECLARATION I solemnly declare that whatever I have stated above is true & correct and hereby undertake that I shall abide by the training requirements/norms of the Institute. PLACE: DATE: SIGNATURE IMPORTANT: / FOR THE LIST OF COPIES TO BE ENCLOSED, SEE THE NEXT PAGE / Enclosures Enclosures for those who have completed 15 months management training Put a tick mark Enclosures for those who are exempted from undergoing management training 1. Application form in the prescribed format. 1. Application form in the prescribed format. 2. Copy of Final / Professional programme passing certificate 2. Copy of Final / Professional programme passing certificate 3. Copy of Institute’s sponsorship letter for undergoing training. 3. Copy of the exemption letter from the Institute. 4. Copy of Training Orientation Program / Executive Development Programme completion certificate. 4. Passport size photograph – 1 5. Copy of Academic Development Programs / Professional Development Programmes completion certificate. 5. Fee: Cash / Cash Receipt No. : [or] DD Put a tick mark DD Details 6. Copy of the 15 months management training completion certificate. 7. Passport size photograph – 1 8. Fee: Cash / DD Cash Receipt No. : [or] DD Details : :