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Bioinformatics Institute of India
C-56A/28, Sector-62, Noida-201301, UP(NOIDA),
Tele:-0120 - 4320801/02,
Mob : 09818473366 ,09810535368,
e-mail: info@bioinformaticscentre.org
Admission cum Registration Form

Advance program in Clinical Trial, Research & Data Management
(6 Months Classroom Weekend Program)


Paste your self attested photograph
All columns are compulsory, No column should be left blank, All in block letters
1. Candidate’s Name
____________ ____________ ____________
(First) (Middle) (Last)
2. * Father's / Husband’s Name _______________________________
3. Date of Birth
               
    (DD       MM           YYYY)
4. Sex
Male
Female
5. Address for Correspondence
_______________________________		 _______________________________________________
State _____________________ PIN ________________
  Country _________ Nationality ___________
6. Telephone No. (if any) (Code)_________(O)_____________(R)_____________
(Mob)_____________
7. e-mail ___________________ @_____________
8. Academic Qualifications
Exam Passed Board / University Year Result with percentage Division
         
         
         

9. Work Experience (If Applicable)
Name of Organization

 Designation

Total Work Experience
(in years)
     
     

10. Crossed Demand Draft No. __________ dated _______ Drawn on ____________________ for Rs. __________
 
(Bank draft must be drawn in favour of Bioinformatics Institute of India payable at New Delhi/ Delhi. Candidates are advised to write their name and address at the back of demand draft)
11. Documents to be attached with application form:
i) Fee draft
ii) Certificates of the qualifying examination
iii) One passport size photograph
** Important Note:
The program in which you are seeking participation, is BII's independent knowledge enhancement program, which gives insight about mentioned study areas. The program does not promise any job guarantee nor provides any specific eligibility to pursue higher studies.In case of any dispute, it would have to be got resolved through arbitration under Arbitration and Conciliation Act 1996 by the sole arbitrator appointed by Bioinformatics Institute of India, Noida. The jurisdiction of the same will be to the Courts of District Gautam Buddha Nagar, Noida only.Fee once deposited is neither refundable nor adjustable under any circumstances.
*Mandatory to fill
*For downloaded forms from internet add Rs.300/- as application processing fee to the Program Fee.
BII:-:-:- Bioinformatics Institute Of In
**Declaration by the Participant

I declare that I have carefully read and understood the details of the above program and that i have given the true and correct information while filling up the form. It may be open for the Institute ot take action in case any of the information given by me is found incorrect.

Date : _____________
(SIGNATURE OF THE PARTICIPANT)
Place : _____________

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