REGISTRATION PROFORMA

FICCI Business Delegation as a part of the CACCI President,

Ambassador Benedicto Yujuico’s official Business Delegation to Iran

December 5-7, 2010, IRAN Name :_______________________________________________________

Designation :_______________________________________________________

Company :_______________________________________________________

Address :_______________________________________________________

Tel. :___________________ Cell : _______________________________________

Fax: ________________________________________________________________

E-mail:____________________________Website:__________________________

Specific Business Interests with IRAN (in brief):

___________________________________________________________________________________________

___________________________________________________________

Diet Preference : Vegetarian Non-vegetarian

Hotel Requirement

Single Double Suite

Registration Fee : Enclosed Yes Yes No No

Photographs (two) : Enclosed Yes Yes No No

Passport Details:

Passport No. ________________ Date of Issue: ___________________

Place of Issue _______________ Date of Expiry ___________________

Refund of delegation fee in case of withdrawal will be as follows: prior to 10 days - 50%, less than 5 days - nil

Please complete this Registration Proforma and send it along with a cheque/DD for Rs.10, 000/- in favor of

“FICCI” Federation House, Tansen Marg, New Delhi - 110 001 and two colored passport size photographs at

the earliest.

TO

Ms. Deepti Sayana, Research Associate, ASEAN& Pacific Countries,

FICCI, Federation House, Tansen Marg, New Delhi - 110 001

Tel: 011 23738760-70 (Ext-330), Dir: 23765321, Fax : 23721504, 23320714

Email: deepti.sayana@ficci.com

NOTE :

• KINDLY SEND A BRIEF PROFILE OF YOUR ORGANISATION WITH THIS PROFORMA (Not more than 100

words)

• AIR FARE, HOTEL ACCOMMODATION & ALL LOCAL EXPENSES WILL BE BORNE BY THE DELEGATES

THEMSELVES