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(ITP Web Registration Acknowledgement Form) TIN NO: Name of Applicant Date of Birth Date:______________ ACK NO. 114917140A

:Mr Ankush Arora

Please affix your latest Photograph

:07-Jan-1993

:Payment to POS( 337) Mode of Payment Please pay exact amount in cash to the POS office.

Employer Name :-Employee Number

:-

Signature (Please sign in the centre of the box)

Valid Up To Date :21/05/2014

Note : * To complete your registration please visit any Point of Service (POS) office. If you do not complete your registration within 50 days of issuance of Acknowledgement Number, your data will be purged from the system. * You need to take print-out of this form to the POS along-with ORIGINAL proof of Photo Identity [Voters Id card/Passport/Driving License/Bank Pass Book (with Photo)/College ID card (not more than 4 years old)/PAN card/Employment Identity Card]. * I have read, understood and I agree to the terms and conditions available on NSR website https:\\nationalskillsregistry.com relating to my joining and using NSR and I agree to the same.

TIN NO :

ACKNOWLEDGEMENT SLIP(For the use of POS only) Ack No : 114917140A POS ID :

Name of Applicant : Mr Ankush Arora 1. Received the Application form for Registration as ITP in the National Skills Registry. 2. Received Cash/DD ______________________ dated____________________ drawn on ___________________________________ for 337 only for Registration as ITP in the National Skills Registry (NSR). Date:___________ (POS Seal and Signature) Print

file://G:\ITPOfflinePaymentModeAction.do.htm

4/6/2014