Registration Form 2019

Registration Format for Emerging Asia Insurance Awards

Delegate Registration

Your Organization

(For more delegates you can use a Photocopy of this form)

Payment Information for Registration

The Programme commences
from 8.45 a.m.

Delegate Fee: ₹ 40,000 /- per delegate Inclusive GST
( Payment by NEFT only)
₹ 52,000 /- per delegate with 2 nights accommodation only in single occupancy at Bangkok, Inclusive GST
( Payment by NEFT only)
(excluding air fare & accomodation)
Supplier/Contractor Name: INDIAN CHAMBER OF COMMERCE
MICR No. 700012016
Account Type (Savings /Cash Credit/Current): Current
Account Number (as appearing on cheque book): 00290200000821
IFSC Code of the Branch (For RTGS/NEFT): BARB0INDIAE (the 5th character is numeric zero)

Kindly send in duly filled Registration Form

Indian Chamber of Commerce, 4, India Exchange Place, 9th Floor, Kolkata 700 001
Phone: 033 - 2230 3242-44/ (D) - 2253-4328/4334
Fax: 033 – 2231 3377

Ms. Alakananda Roy

Contact Number: 7278084887 /8981678106

Ms. Moumita Mazumder

Contact Number: 9830133309