Name:

N A V E E D A K H T A R

Nationality:

P A K I S T A N I ID No in Company x M T 3 0Department in Company x C P D I V

Company:

M - T E C H I N T E R N A T I O N A L L L C

Address:

S U I T E N O 5 0 5 C I T Y T O W E R 2

City:

D U B A I

Country:

U N I T E D A R A B E M I R A T E S

Business Phone: Business Fax:

+ 9 7 1 4 3 5 8 6 6 9 2 + 9 7 1 4 3 5 8 6 6 9 3

Private Phone:

9 7 1 5 6 3 6 2 4 6 8 7

E-mail:

S A L E S C P . U A E @ M T E C H I N T L . C O M

Date of Birth: dd/mm/yy

0 3 0 2 1 9 8 8

Course Registration No: NACE Membership No 5 6 4 5 1 8

Payment to be made with Bank details as below:

Payments to be made in favour of: Insignia FZE, Dubai, U.A.E.Bank: Emirates NBD, Festival City Branch, Dubai, UAEAccount No. AED A/C # 101-10663666-02( IBAN NO.AE050260001011066366602 ) Account No. USD A/C # 102-10663666-01(IBAN NO. AE670260001021066366601 ) SWIFT Code - EBILAEAD

Please note that this is net amount payable. Bank charges to be added extra.Cancellation and Refund Policy

Paid or guaranteed registrations cancelled in writing at least 30 calendar days in advance of the contact programme willreceive a full refund less the course Registration and service fee of Dirhams 1500/-. No refunds or credit will be issued oncancellation requests received less than 30 days before the contact programme begins.

For Further information Contact: Mr. Pradeep Radhakrishna/ Ms Thulasi. Office Tel. +9714 8813067Fax +9714 8813068Email -wgarnet@eim.ae; insignias@eim.ae

NACE Course Resistration Form - 2013

CP1

Payment Details