Nomination Form

To,

The Director
Bankers Institute of Rural Development
Sector H, LDA Colony, Kanpur Road
Lucknow -226012
Phone : (0522) 2421154, FAX : (0522) 2421047/2421176

Title of Training Programme

Dates of Training Programme

From

(dd/mm/yyyyy)

Name of the Bank/Training Institution
Address of the Nominating Office
Details of the Officer (S) nominated for the Programme

Sl. No.	Name	Qualification	Designation+ Present function	Address	Phone/Fax No
1-
2-
3-
4-
5-

Participation Fee

For Rs

DD No.

Dated

(dd/mm/yyyyy)

Name
Designation
Date of Submit	(dd/mm/yyyyy)

For More Nomination please fill another form.