Registration Form

Training Center Name

: .......................................................................................

Training Center Address

: .......................................................................................

Course Name/Sector

: .......................................................................................

Batch Start Date

: .......................................................................................

Batch End Date

: .......................................................................................

Course Duration

Please affix
passport size
photograph

: .......................................................................................
Personal Details

First Name:

Last Name:

Gender:

Male

Female

Date of Birth:

Marital Status

Married

Single

Age (Years):

__/__/____

Mobile Number:

Landline Number:

E-mail ID:

Aadhaar Card / EID No.:

Address Details
Current Address

Permanent Address

Door Number:

Door Number:

Street Name:

Street Name:

Village /City:

Village /City:

District:

District:

State:

State:

Pin code:

Pin code:
Family Details
Family Details

Guardian's Details

Fathers' Name:

Guardian's Name:

Mother's Name:

Relationship:

Father's Occupation:

Occupation:

Mother's Occupation:

Guardian's Contact No. :

Father's Contact No. :

Family Income:

Category:

Religion:

Caste:
Education Details

Work Experience

Education Qualification:

Experience in Years:

Pass out year:

Current Employer:

Institution:

Employer Address:

% Marks obtained:

Payment Details
Student Name:
Course Name:
Total Fees:

Agreed Amount:

Discount Amount:
Discount Summary:
Payment Type:

EMI

Lump Sum
Next Payment date &

Payment Now:

Amount

Receipt No. :

Admission Date:
Documents to be enclosed

Sl. No.

Documents to be attached

Identity Proof ( DL, Election Card, Pan Card, Ration card)

Mark Sheet - Highest Qualification

Address Proof - Pan Card, Ration Card

Employment Letter or proof of Working People

Photocopy of Receipt Slip

Any other, please specify

Not Applicable

Bank Account Details

Account No. :
Branch:

IFSC Code

Student Declaration:

I .........................................................S/O...................................................declare that all information provide

by me is true to best of my knowledge and belief. I hold myself solely responsible if any information is falsely
provided or found incorrect.

Date:
Place:

Signature of the Candidate

Authorized Signatory