GOVERNMENT OF INDIA MINISTRY OF LABOUR AND EMPLOYMENT

ADVANCED TRAINING INSTITUTE FOR ELECTRONICS AND PROCESS INSTRUMENTATION

RAMANTHAPUR, UPPAL ROAD, HYDERABAD - 500 013.

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APPLICATION FORM FOR SHORT TERM COURSE

Registration Fee Rs. 100/Course Code :

Name of the Course : From Name of the Applicant (in BLOCK LETTERS) Fathers Name Date of Birth Address for Communication Whether belongs to SC/ST/PH/OBC To

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Permanent Address

Details of qualifying examination passed : (B.Sc / Diploma / ITI (NCVT / NAC)

Name of the examination B.SC / B.TECH / B.E Diploma ITI (NCVT / NAC) University / Board / Council Trade / Branch Group Maximum Marks Marks Obtained Percentage of Marks

Details of Demand Draft/PO/Cash Receipt No. & Date : I hereby declare that the information given above is true and correct to the best of my knowledge. Signature of the Applicant Date: For use in the case of sponsored candidates: The information furnished above by Sri. / Smt. / Kum. ____________________________ employed in our organization has been verified and is herewith forwarded for admission upto _________________________ (course name) as a sponsored candidate. The prescribed fee will be paid by us.
Signature & Designation of the sponsoring authority List of Enclosures : 1) IPO/DD of Rs. 100/- Registration drawn in favour of DDo, ATI-EPI, Hyderabad. 2) Attested copies of mark sheets and certificates in support of qualifying examination.