10/16/2014

::: Citibank Payment Gateway :::

(ITP Web Regis tration Ack nowledgement

Form)
TIN NO:

Date:

ACK NO. 116264519H

Name of Applicant

:Ms Syamala Kanakavalli Achalla

Date of Birth

:06May1994

Mode of Payment

:Payment by Online ( 337)

Employer Name

Employee Number

Valid Up To Date

:05/12/2014

Please affix your

latest Photograph

Signature
(Please sign in the centre of the box)

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 printout of this form to the POS alongwith ORIGINAL proof of Photo Identity [Voter's 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:\\ nati onal skill sregi stry. 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 : 116264519H
POS ID :

Name of Applicant : Ms Syamala Kanakavalli Achalla

1. Received the Application form for Registration as ITP in the National Skills Registry and payment
made by ITP for Registration is Payment through Online.
Date:
(POS Seal and Signature)
Print

https://nationalskillsregistry.com/nasscom/pg/OnlinePayment
1/1