CHRYSALIS
Certificate Course in Corporate Yoga
Application From
Please fill this form carefully, write legibly in capital letters  
1. Name (Capital Letter)  
2. Date of Birth and Age  
3. Sex  
4. Marital Status  
5. Permanent Address  
  Temporary Address  
6. Phone  
7. Fax  
8. Email (if any)  
9. Name of Father/ Guardian  
10. Nationality  
11. Qualifications
(Attach Certificate of Highest Exam Passed) (Student should give the name of School / College / University)
 
12. Occupation  
13. Starting date of the course  
14. Mention the yoga certifications and institute  
15. Experience as a social worker (if any) address of the organisation in which you have worked  
16. a) Health status  
  b) Ailments if any  
17. For NRIs  
  a) Passport No  
  b) Visa details  
Applicant
Photo
I have gone through the details of the course prospectus and instructions. I hereby agree to abide by all the rules and regulations of your institution.
Date :  
Place: Signature of Student

Please Note : Along with this application form send Your Cheque/ Demand Draft in favour of  "Soulgenie Health Pathways LLP" payable at Delhi for RS. 6000/ to the following address.

Soulgenie Health Pathways LLP
B-36, Sector-31,
Noida 201301
U.P, India


FOR OFFICE USE
 
18. Receipt No  
19. Date  
20. Rs  
21. In words Rs  
22. Cheque/ Demand Draft No.  
23. Date  
24. Bank Name  
25. REMARKS  
 

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