Lab Result

Your OTP (One time password) received you your registered mobile number.
For Reg. No. & OPD/IPD/EM No., please refer to the respective Bill Receipt.

Request a Callback

ISPGHAN Pediatric Gastroenterology Fellowship 2017-18
  • Home
  • All News
  • ISPGHAN Pediatric Gastroenterology Fellowship 2017-18

ISPGHAN Pediatric Gastroenterology Fellowship 2017-18

01 Aug 2017
<p class="MsoNormal" style="margin: 0in -0.25in 0.0001pt 0in; text-align: center;" align="center"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong><span style="font-size: 12pt;">ISPGHAN Pediatric Gastroenterology Fellowship 2017-18</span></strong></span></p> <p class="MsoNormal" style="margin: 0in -0.25in 0.0001pt 0in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>&nbsp;</strong></span></p> <p class="MsoNormal" style="margin: 0in -0.25in 0.0001pt 0in; text-align: center;" align="center"><strong><em>&nbsp;</em></strong></p> <p class="MsoNormal" style="margin: 0in -0.25in 0.0001pt 0in; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong><em>Indian Society Pediatric Gastroenterology, Hepatology and Nutrition&nbsp;</em>(ISPGHAN)</strong>&nbsp;invites application for the entrance examination for Fellowship of duration one year for the academic session starting from 01 August 2017, as per the details given below:</span></p> <p class="MsoNormal" style="margin: 0in -0.25in 0.0001pt 0in; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">&nbsp;</span></p> <p class="MsoNormal" style="margin: 0in -0.25in 0.0001pt 0in; text-align: justify;"><span style="text-decoration: underline;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>Eligibility and Selection of candidates</strong></span></span></p> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; text-indent: -.25in; line-height: 150%; mso-list: l3 level1 lfo2; margin: 0in 0in .0001pt 58.5pt;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">1.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;</span>Eligibility would be MD/DNB Pediatrics from MCI recognized medical college/ institutions (Govt. recognized)</span></p> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; text-indent: -.25in; line-height: 150%; mso-list: l3 level1 lfo2; margin: 0in 0in .0001pt 58.5pt;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">2.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;</span>Selection would be made on the basis of written test.</span></p> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; text-indent: -.25in; line-height: 150%; mso-list: l3 level1 lfo2; margin: 0in 0in .0001pt 58.5pt;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">3.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;</span>Departmental Interview would follow after short listing on the basis of the written test.</span></p> <p class="MsoNormal" style="margin: 0in -0.25in 0.0001pt 0in; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">&nbsp;</span></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid black .5pt; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt;" border="1" cellspacing="0" cellpadding="0"> <tbody> <tr> <td style="width: 54.9pt; border: solid black 1.0pt; mso-border-alt: solid black .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="73"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;" align="center"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong><span lang="EN-IN">S.No.</span></strong></span></p> </td> <td style="width: 315.0pt; border: solid black 1.0pt; border-left: none; mso-border-left-alt: solid black .5pt; mso-border-alt: solid black .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="420"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;" align="center"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong><span lang="EN-IN">Name of the Training Centre</span></strong></span></p> </td> <td style="width: 108.9pt; border: solid black 1.0pt; border-left: none; mso-border-left-alt: solid black .5pt; mso-border-alt: solid black .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="145"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;" align="center"><span lang="EN-IN" style="font-family: 'book antiqua', palatino; font-size: 10pt;"><strong>Seats</strong></span></p> </td> </tr> <tr> <td style="width: 54.9pt; border: solid black 1.0pt; border-top: none; mso-border-top-alt: solid black .5pt; mso-border-alt: solid black .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="73"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;" align="center"><span lang="EN-IN" style="font-family: 'book antiqua', palatino; font-size: 10pt;">1.</span></p> </td> <td style="width: 315.0pt; border-top: none; border-left: none; border-bottom: solid black 1.0pt; border-right: solid black 1.0pt; mso-border-top-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-alt: solid black .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="420"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-IN" style="font-family: 'book antiqua', palatino; font-size: 10pt;">Sir Ganga Ram Hospital, New Delhi</span></p> </td> <td style="width: 108.9pt; border-top: none; border-left: none; border-bottom: solid black 1.0pt; border-right: solid black 1.0pt; mso-border-top-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-alt: solid black .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="145"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;" align="center"><span lang="EN-IN" style="font-family: 'book antiqua', palatino; font-size: 10pt;">1 Seat</span></p> </td> </tr> </tbody> </table> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">&nbsp;</span></p> <p class="MsoNormal"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong><span style="text-decoration: underline;">How to Apply</span></strong></span></p> <p class="MsoListParagraphCxSpFirst" style="text-align: justify; text-justify: inter-ideograph; text-indent: -.25in; mso-list: l0 level1 lfo1;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 115%;">1.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 115%;">The candidates who are interested to apply for the above course should apply at the contact address mentioned below</span>.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">2.<span style="font-stretch: normal;">&nbsp;&nbsp;&nbsp;&nbsp;</span>The last date for online application for the above course is 10<sup>th</sup>&nbsp;July, 2017</span></p> <p class="MsoListParagraphCxSpLast" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">3.<span style="font-stretch: normal;">&nbsp;&nbsp;&nbsp;&nbsp;</span>Please attach a self attested passport size photograph.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">&nbsp;</span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="text-decoration: underline;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>Venue of Examination:</strong></span></span></p> <p class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">&nbsp;</span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify;"><strong><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">Sir Ganga Ram Auditorium</span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">Working Womens hostel building</span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">Sir Ganga Ram Hospital</span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify;"><strong><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">Rajendar Nagar,&nbsp;</span>New Delhi 110060</strong></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">&nbsp;</span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">&nbsp;</span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="text-decoration: underline;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>Entrance test:</strong></span></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">The Entrance written Examination will be conducted on 16<sup>th</sup>&nbsp;July 2017 at 10 am to 12:30 pm.</span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">Please carry a photo ID card at the time of the examination.</span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>&nbsp;</strong></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="text-decoration: underline;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>Contact addresses:</strong></span></span></p> <p class="MsoListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">1.<span style="font-stretch: normal;">&nbsp;&nbsp;&nbsp;&nbsp;</span>Dr. Anand Gupta</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">Room number 1193, First floor, Old building</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">Sir Ganga Ram Hospital,New Delhi.</span></p> <p class="MsoListParagraphCxSpLast" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">Telephone numbers: 01142251193, 9968856750, 9878709965</span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>&nbsp;</strong></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>_____________________________________________________________________________________________________<br /><br /><br /><br />Application Form &nbsp;<br /><br />ISPGHAN Pediatric Gastroenterology Fellowship 2017-2018</strong></span></p> <div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><strong>&nbsp;<br /></strong></span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 1.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Name &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 2.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Gender</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 3.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Date of Birth</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; : &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 4.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Nationality</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; : &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 5.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">MD/DNB Pediatrics:</span></span></div> <div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in; line-height: 200%; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">a.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Institute / Affliated University</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp;</span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in; line-height: 200%; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">b.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">MCI recognized &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Yes/ No</span></span></div> <div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in; line-height: 200%; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">c.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Duration &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp;</span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; : &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span><span style="line-height: 200%; font-family: 'book antiqua', palatino; font-size: 10pt; text-indent: -0.25in;">&nbsp;</span></div> <div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in; line-height: 200%; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">d.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Year of Passing &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp;</span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp;: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in; line-height: 200%; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">e.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Passed in First Attempt / Multiple Attempts</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">: &nbsp; &nbsp; _________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 6.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Email:</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; : &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 7.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Telephone Number:</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; : &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 8.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Address:</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 200%;"><span style="font-size: 10pt; line-height: 200%; font-family: 'book antiqua', palatino;">&nbsp;</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 200%;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">&nbsp; &nbsp; &nbsp; &nbsp; 9.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">MCI registration Number:</span></span></div> <div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in; line-height: 200%; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;"><span style="line-height: 200%;">a.<span style="font-stretch: normal; line-height: normal;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span><span style="line-height: 200%;">Central / State</span></span><span style="font-family: 'book antiqua', palatino; font-size: 13.3333px; line-height: 26.6667px;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; : &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________________________</span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 200%;"><span style="font-family: 'book antiqua', palatino; font-size: 10pt;">&nbsp;<br /><br /></span></div> <div class="MsoListParagraphCxSpLast" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 200%;"><strong><span style="font-size: 14.0pt; line-height: 200%; font-family: 'Times New Roman','serif';"><span style="font-size: 10pt; font-family: 'book antiqua', palatino;">Signature of the Applicant</span></span></strong></div>