ACADEMY OF MINIMALLY INVASIVE LASER SURGERY

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LASER WORKSHOP

NAME *

MOBILE NO *

CITY *

Specialty *

Which Medical Program for Training *

Proctology

Varicose Veins

Cosmo Gynecology

Microwave Tumor Ablation Training Program

Erectile Dysfunction

Required

Date To Attend *

Name to be printed on Certificate

GOOGLE PAY : 9322673077

BENEFICIARY : ANALYTICALS MEDICAL TECHNOLOGIES PVT LTD.
BANK NAME : ICICI BANK LTD.
BANK ADDRESS : TALOJA, MIDC, NAVI MUMBAI.
ACCOUNT NUMBER : 425005500120
IFSC CODE : ICIC0004250

BENEFICIARY : ANALYTICALS MEDICAL TECHNOLOGIES PVT LTD.
BANK NAME : AXIS BANK LTD.
BANK ADDRESS : KHARGHAR, NAVI MUMBAI.
ACCOUNT NUMBER : 922020011152904
IFSC CODE : UTIB0004827

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