Óbuda University
John von Neumann Faculty of Informatics
APPLICATION FORM
CISA ® Review Course 2017
PERSONAL DATA OF THE APPLICANT
NAME: ........................................................................................................................
Maiden name: ..........................................................................................................
Date and place of birth: .............................................................................................
Mother’s maiden name: ............................................................................................
Notification address: .................................................................................................
.....................................................................................................................................
Phone: ......................................................................................................................
E-mail: .......................................................................................................................
PAYMENT DATA
Name of company: .....................................................................................................
Address: ...................................................................................................................
Tax number: ................................................................................................................
Account number: .......................................................................................................
Referee: ....................................................................................................................
Phone of referee: ......................................................................................................
E-mail of referee: ......................................................................................................
Price: 260.000.- Ft- + VAT
The bank transfer is to refer to this course.
Date: .........................................................
......................................................
Signature of Applicant
... ..........................................................
Authorized signature, stamp of company
1034 Hungary Budapest, Bécsi str. 96/b. www.nik.uni-obuda.hu
Tel.: (36-1) 666-5541 Fax.: (36-1) 666-5522
[email protected]