GatePass

SSE/Concerned

Pleasearrangepracticaltraininginmarkedareasandsendattendancesheetdulysigned.Pleasealsoensurethatthe
traineeshouldbeequippedwithPPE's(safetyhelmet&shoesetc.)

RegistrationNo. TTC/DLW/17/1254

Name navdeepkumarpandey

FatherName sadanandpandey

Email navdeepbraecit@gmail.com

DateofBirth 30/06/1995

MobileNo. 8400585140

BranchName MECHANICALENGINEERING

CollegeNamewithcityname RAJKIYAENGINEERINGCOLLEGE,BANDA

YearinStudying ThirdYear

TrainingMonth JUNE

TrainingDuration(Inweeks) 6

FOROFFICEUSEONLY:

TrainingTime* Morning AfterNoon

TrainingDate* From. To.

TrainingArea* ......................................................................................................................................

SignatureOfTrainingIncharge
 AnnexureI

FORMATFORDECLARATIONBYINTERNS
1.WithreferencetotheofferforinternshipvideletterNo...................................................dated.........................,Iherebyundertakethefollowing:
2.Iwillbedoinginternshipfrom...................................to..................................atDieselLocomotiveWorks(DLW),Varanasi.
3.Iamnotentitledtoanyremunerationintheformofstipend,salaryorallowancesofanykindbytheDLW.IamalsonotentitledtoanypassorPTOfrom
IndianRailways.
4.IwouldabidebyallGeneralrulesandregulationsofdisciplineandconductattheDLW,Varanasi.
5.IamliabletocompensatetotheDLWforanylossordamagetoequipmentandfittingsthatmaybecausedduringthecourseoftraininginworkshopsetc.
6.IwouldnotbetreatedasemployeeofIndianRailwaysandassuchwillnotbeentitledtoanycompensationordamagefromtheDLWforanyinjurytome
ortomypropertyetc.
7.IagreetobeundertheadministrativecontrolanddisciplineoftheTechnicalTrainingCentre,DLW,Varanasi.
8.IwillnotclaimanyadvantageforemploymentinIndianRailwaysinfutureonthebasisoftheinternships.

Date:.....................................

Name:....................................

Institute:...............................

Course:..................................

DeclarationbytheGuardian/Parent
........................................................undertakestoindemnifyDLW,VaranasiforanylossordamagetoequipmentandfittingsthatmaybecausedbyMr/Ms(
............................duringhis/herinternshipwithIndianRailways.

(AuthorisedSignatory/SignatureofGuardian)

NameoftheGuardian/Parent:.

RelationwithTrainee(Son/Daughter/OtherPleaseSpecify)........................

AddressoftheGuardian/Parent:.

ContactNo.(Mobile/Landline).....................................................................

Email(ifany).....................................................................................

NameofTrainee:navdeepkumarpandey RegistrationNo.:TTC/DLW/17/1254
TrainingMonth:JUNE BranchName:MECHANICALENGINEERING

DeclarationforInternship(bytrainees)
Iherebydeclaredthat:
1.Ialwaysusesafetyequipmentslikesafetyhelmet,safetyshoe,andlabcoat(forladies)duringtrainingwhichwillbearrangebyme.
2.AsIenteredinDLWpremises,Iwillfollowtheallrulesandbylawsoftraining.
3.Asavocationaltrainee,IwillnotharmtheDLWproperties.
4.Duringtrainingperiod,Iwillfollowtheinstructionsgiventomebytheinstructors/trainingincharge.
5.Iwillattendthetrainingregularly.
6.Iwillneverinterrupttheworkbygatheringwithothertrainees.
7.ThisiswellknowntomethatifIdoindisciplinebymyactivity,thiswillbeintimatedtomyguardianandinstitute.
8.Thisiswellknowntomethatmytrainingcanbepostpone/prepone/curtailorcancelonanytimebytheDLWadministration.
9.IwillfollowtherulesofDLWforquality,environment,healthandsafetymanagement.
10.InDLWpremisesespeciallyinworkshop,Iwilldotrainingonmyownriskandnoanycompassionclaimshallbedonebymeincaseofany
accident/casualty.

CandidateSignature
Nameof
BranchName
trainee
FirstWeek: ShopName
Day . . . . .
Date
Signatureof
concerned
SSE/SSO Fullname&sealofSSE/SSO

Second
ShopName
Week:
Day
Date
Signatureof
concerned
SSE/SSO Fullname&sealofSSE/SSO

Third
ShopName
Week:
Day
Date
Signatureof
concerned
SSE/SSO Fullname&sealofSSE/SSO

Fourth
ShopName
Week:
Day
Date
Signatureof
concerned
SSE/SSO Fullname&sealofSSE/SSO

FifthWeek: ShopName
Day
Date
Signatureof
concerned
SSE/SSO Fullname&sealofSSE/SSO

SixthWeek: ShopName
Day
Date
Signatureof
concerned
SSE/SSO Fullname&sealofSSE/SSO

Note:EntryinworkshoponSaturdayisnotallowedduetohalfdayworkingOnlyadministrativeworkscanbedone(ifrequired)atTTCon
thisday.
StudentAcknowldgement

NameofTrainee:navdeepkumarpandey RegistrationNo.:TTC/DLW/17/1254
TrainingMonth:JUNE BranchName:MECHANICALENGINEERING

Note:

1.Studentwillsendfilledformalongwithdeclarationformtothefollowingaddressthroughsimplepost/courier/registerspost/byhand

Principal
TechnicalTrainingCentre
DieselLocomotiveWorks,Varanasi221004

2.Checklistforpaperstobesend

a.GatePass

b.AttendenceSheet

c.CollegeRequestletter(inoriginal)

d.DeclarationbyInternandGuardian/Parent

e.IfTraineeisRailwayEmployeedependent.He/Shebringaattestedphotocopyofprivilage/schoolpass

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