Earn 2 API Score Credits
PLEASE NOTE:  Kindly fill this form ONLY AFTER COMPLETING PAYMENT AND NOTING RECEIPT NUMBER 
(For Payment, please visit https://imjo.in/UsHV9s)

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* 1. Payment Receipt ID Number

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* 2. Date of Payment 

Date

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* 3. Gender

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* 4. Salutation / Prefix  (Certificate)

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* 5. Name with initials (Please enter Carefully) (CERTIFICATE)

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* 6. Designation

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* 7. Name of Institution / Organisation (CERTIFICATE)
Freelancers can type 'NA'

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* 8. E-mail ID  [Error in typing will result in non-receipt of communication]

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* 9. Mobile Number (WHATSAPP)
[Error in typing will result in non-receipt of communication]

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* 10. State / UT (Example: Himachal Pradesh; Pondicherry; Istanbul)

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* 11. Country (Example: India; Turkey; Sri Lanka)

Please Verify all details before submitting.  

For any queries, please contact: Prof. Dr. B. Balaji
drbbalaji@specialminds.in / + 91 95000 46890

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