THE INSTITUTE OF FINANCE MANAGEMENT Application for Workshop Offered by the Institute of Finance Management for academic year 2015 FOR OFFICIAL USE ONLY Date of receipt Application fee receipt No Amount Admission number Signature TO BE COMPLETED BY APPLICANT Workshop Name: ICT SECURITY Location of study (if applicable to your choice) Morogoro ( ), Mwanza( ) .Tick (√ ) as appropriate APPLICANTS PERSONAL PARTICULARS 1. Last name (Capital letters)_____________________________________________________ First name ____________________________________ Initials________________________ Note: The names entered on this form will be the names which will appear in your certificate. 2. Sex _____________________________ (3) Date of Birth ___________________________ 4. Place of birth______________________ (5) Religion _______________________________ 6. Marital Status _____________________ (7) Citizenship ____________________________ 8. Permanent Address _________________________________________________________ _________________________________________________________ E-mail address __________________________________________________ Telephone number_______________________________________________ 9. Name and address of person to be notified in case of emergency Name______________________________________________________________ Relationship ________________________________________________________ Address _____________________________________________________________ 1 Telephone___________________________________ email____________________ FULL NAME OF APPLICANT _______________________________ DATE:_______________________SIGNATURE:________________ YOU CAN PAY THE COURSE FEES TO: THE INSTITUTE OF FINANCE MANAGEMENT BANK: CRDB, TOWER BRANCH.ACCOUNT NUMBER 01J1042984102. Note: You can pay at any CRDB Branch in Tanzania. You need to attach the paying –in-slip with your form. You are advised submit the pay-in-slip to room 320 (3rd floor), IFM, Block A, where you will be issued IFM receipt of payment. Your form will not be processed without the payment. Submit your form with copy of IFM receipt to Secretary of Director of Computer Service (4th floor), Block A. 2