Name the Delegate  

CS Membership No. / CS Registration No. / Non- Members 

Contact No. 

e-mail id

Fees for CS Members/ Non-Members/ Students on (Rate are Inclusive of Taxes).

Payment Details (UPI No./ UPI Id/ Transaction No. etc.)

Details for Payment Through Online Mode as details given below: 

Name of Account – Belagavi Chapter of SIRC of ICSI

Bank Name – Yes Bank

Bank A/c Number - 101094600000077

IFSC Code – YESB0001010

Branch – Khanapur Road

Whether Transport Facility to the Venue Required ? 

YES/ NO

Members Required to Enter the NEFT or UPI Reference No.

Bank Name

Branch Name

GST if any? Yes/ No.

Please provide the GST No. and Company Name