Fellowship TEE FTEE Application Form
Fellowship TEE FTEE Application Form
Fellowship TEE FTEE Application Form
Cheque (multi city) Remit in any SBI branch to the account number given below and
or Cash mail the counterfoil of the Pay - in-Slip to the ICCA office.
Electronic State Bank of India, PBB, Senapati Bapat Road Branch, Pune
Transfer
(As NEFT) Account No: 30007410621 Account Name: IACTA IFS Code: SBIN0004120
DETAILS OF PAYMENT:
2. (A) Log book of 100 cases, certified by HOD/Mentor (If the applicant is HOD, self-certification is
acceptable)
(B) CD or Pendrive containing TEE loops & images of 25 patients with the name of the candi-
date as the primary echocardiographer. Include only relevant (labelled) loops & images of
each patient. It is advisable to bring your own laptop to demonstrate before the examiners.
3. Examination fee is Rs 10000 for the first attempt. Fee for the second or subsequent attempts is
also Rs 10000. For payment options see above.
4. Candidates who do not appear for the examination will forfeit the amount except under
exceptional circumstances. Students who could not appear due to medical reasons will have
to pay Rs 5000 at the next attempt. Medical reasons given will be verified by the IACTA office.
6. Last date of application is one month before the examination. Last date for cancellation
is two weeks before the examination.
Amount:..........................................................Receipt No:.................................................................................................................