CENTRAL TOOL ROOM AND TRAINING CENTRE

(An Indo-Danish Project , A Govt. of India

Society )
Plot No.-B-36 , Chandka Industrial Area
Bhubaneswar - 751 024 (Orissa)

APPLICATION FORM FOR ADMISSION INTO

......................................................................................

(NOTE: Please use the Print option on your browser to make a hard copy of this
form, fill it up and mail it to the address given on the form along with the draft.)
1.Name
:Mr./Miss

________________________________________________________

2.Father's Name

________________________________________________________

3.Sex (M/F)

________________________________________________________

4.Date Of Birth

________________________________________________________

5.Address for
correspondence:

________________________________________________________
________________________________________________________
____________________________________Pin _________________

6.Phone /Fax No.

(If any)

________________________________________________________

7.Qualification

________________________________________________________

Degree/Diploma in

____________________________ age of Marks in final or prefinal

________

8.Payment of Registration fees details

D/D No.______________________
Name of the Bank
___________________Place_______________________
9.Category :

In case of

Non Sponsored
Signature with seal

Sponsored

sponsored
candidate:
Name & Address of Sponsoring Authority
DECLARATION
I do here by declare that I shall be abided by the rules and regulations of the Centre.

Place :
Enclosure: Final / Pre final Year Mark sheet
copy

Signature of the candidate