ICSI Observer - Empanelment Form

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Empanelment for

Type

Membership No. / Employee Code

Date of Birth:

Personal Information

Name *

Date of Birth*

Date of Enrollment/Joining *

Gender

Address *

State *

City *

Pin Code *

Mobile 1: (self) *

Mobile 2: (Optional) (self)

E-mail ID: (self) *

E-mail ID - 2: (Optional) self

Phone (Office with Std Code)

Phone (Residence with Std Code)

GST No. (Optional)

Select Exam City Preferences 1

Select Exam City Preferences 2

Select Exam City Preferences 3

Select Exam Date(s)Preference for Duty [Minimum 1 Day and Maximum ALL Days] Select all exam dates

Select Zone Preferences *

Areas:

Zone	Areas	#

Upload Photograph and Signature

Photo (passport size colour photograph 4.5 CM X 3.5 CM). Note -size 40 KB to 100 KB and format in jpeg, jpg, png)*

Signature (Note – size 40 KB to 100 KB and format in jpeg, jpg, png)*

Bank Details

IFSC CODE *

Name of the Bank *

Bank Branch with Address *

Account Number *

Confirm Account Number *

Account Type

PAN NO. *

Upload Blank Cheque (jpeg,jpg,png,pdf) (Maximum size: 2 MB) *

Acceptance-Cum-Declaration

Please tick all check boxes

*DEFINITION OF RELATIVE: THE TERM ''RELATIVE" FOR THE PURPOSE OF EXAMINATION SHALL INCLUDE IN RELATION TO AN INDIVIDUAL, THE WIFE, HUSBAND, SON, DAUGHTER, FATHER, MOTHER, DAUGHTER-IN-LAW, SON-IN-LAW, GRANDSON, GRAND DAUGHTER, BROTHER, BROTHER'S WIFE, BROTHER'S SON, BROTHER'S DAUGHTER, SISTER, SISTER'S HUSBAND, SISTER'S SON, SISTER'S DAUGHTER, WIFE'S BROTHER, WIFE'S SISTER, HUSBAND'S BROTHER, HUSBAND'S SISTER AND THEIR CHILDREN AND ANY OTHER DEPENDENTS/PERSON RESIDING WITH HIM/HER INCLUDING THE TRAINEE STUDENT UNDERGOING TRAINING UNDER HIM/HER.

Disclaimer: Actual allocation of duty as General Observer in the CS Examinations would be at the sole discretion of the Institute and the decision of the Institute will be final. Institute reserves rights for deputing General Observers from among the persons empanelled or otherwise. Empanelment as General Observer shall not give any right to any member/employee/other in any manner.

EMPANELMENT FORM FOR GENERAL OBSERVER FOR CS EXAMINATION - JUNE, 2024

Fill Details

Search Member Information

Personal Information

Areas:

Upload Photograph and Signature

Bank Details

Acceptance-Cum-Declaration

EMPANELMENT FORM FOR GENERAL OBSERVER FOR CS EXAMINATION - JUNE, 2024

Fill Details

Search Member Information

Personal Information

Areas:

Upload Photograph and Signature

Bank Details

Acceptance-Cum-Declaration

Acceptance of Eligibility Criteria for General Observer for CS Examination - June, 2024

INSTURCTONS FOR FILLING-UP THE GENERAL OBSERVERS EMPANELMENT FORM AT ICSI OBSERVER PORTAL