FORM FOR THE APPROVAL FOR THE SUBMISSION OF A DISSERTATION


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INSTITUTE OF CHARTERED SHIPBROKERS

85 Gracechurch Street, London EC3V0AA; Tel: (020) 7623 1111; Fax: (020) 7623 8118;Email:membership@ics.org.uk

Please complete and forward this form to your local branch or Head Office in London

I wish to apply to submit a dissertation in lieu of passing the Professional Qualifying Examinations(PQE) as the entry requirement for membership of the Institute of Chartered Shipbrokers.

PERSONAL DETAILS

Title	:
Surname	:
Given Name	:
Date Of Birth	:
Age	:
Nationality	:
Home Address	:
Address 1 [Optional]	:
Address 2 [Optional]	:
City	:
Country	:
Post Code	:
Telephone No	:
E-mail	:

BUSINESS/EMPLOYER DETAILS


Company Name	:
Address 1	:
Address 2 [Optional]	:
City	:
Country	:
Post Code	:
Telephone No	:
Fax [Optional]	:
E-mail	:

Please direct all my communications to this address

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CAREER DETAILS

Please give dates and details, in reverse chronological order, of all companies for whom you have worked in the past 10 years, with positions held and responsibilities undertaken.

Employer's Name	Designation	Date of Joining	Date of Leaving	Job Description

PROPOSED DISSERTATION TITLE

The proposed title of my Dissertation is

SYNOPSYS

The synopsys is

Last Updated On: February 14 2006