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ENTRY FORM FOR THE FOUNDATION DIPLOMA
 
INSTITUTE OF CHARTERED SHIPBROKERS
85 Gracechurch Street, London EC3V 0AA, Telephone : +44(0)20 7623 1111, Fax: +44(0)20 7623 8118,
E-mail:info@ics.org.uk
I wish to enter for the Foundation Diploma to be held in
Have you registered with the Institute before?
If yes, please give current registration number, if known 		Yes No
Please forward completed form to your local branch or head office if no local branch
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  
Chosen Exam Centre :  
How/where are you studying
:   [e.g. Tutorship]
Total Entry Fee Due : £
SUBJECTS I WOULD LIKE TO SELECT
Group I Group II
Remittance, payable to INSTITUTE OF CHARTERED SHIPBROKERS, must be in Sterling, no other currency will be accepted.
Remit either by Cheque drawn on a Bank with a U.K. Branch or by a Bank Transfer ensuring that ICS receives the Gross Amount (i.e. ALL CHARGES FOR YOUR ACCOUNT).
Bank Details : National Westminster Bank PLC. (Bishop’s Gate Branch)
Bank Sort Code : 50-00-00 BIC NWBK GB 2L IBAN GB55 NWBK 5000 0015 4792 34 
Account Number : 15479234
Institute of Chartered Shipbrokers 
Payment also accepted by credit card (Visa, Mastercard) or debit card (Delta or Switch) Please note 3% will be added to all card transactions. AMEX not accepted.
METHODS OF PAYMENT
Payment details
Cheque
Bank Transfer
Credit/Debit Card
Credit/Debit Card Details
Name on card :
Number :
Security No :
Expiry Date : (MM/YY)
Issue Number (Debit card only) :
3% commission will be charged on all card transactions.(AMEX not accepted)
Cheque Details
Name of Bank :
Sort Code :
Cheque No :
Bank Transfer Details
Name of Bank :
Transaction ID :
 

      
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