DDU-GKY Me SF 6.2A3: Candidate application form- MoRD Logo DDU-GKY/ Roshni logo PIA logo Name of the PIA. DDU-GKY Ministry Of Rural Development, Government of india Name of PIA Name (No.) of Project State Name of Training Centre Address of Train- ing Centre Batch Number Trade Date of Registra- tion Training duration Trainee Profile Name of the Candidate Gender M/F/ Others Individual Identity Number Father/ Husband’s Name Mother's Name Photograph Present Address Permanent Address (if different from above) Contact details Ph: Email Id: Alternative Contact details _| Ph: Email Id: Date of Birth Age 4# Or alternative records used by RSBY, as notified by the state governmentDDU-GKY {#8 Screen shot from nrim.gov.in covering the Name of SHG, SHG Id and Name of member shall be ‘enclosed along with the declaration from SHG office bearer stating that the candidate belongs to the family of the SHG member Family Details: Name of the head of the family: Highest educational qualification of the head of the family: Yearly Income of the family (Rs.): Number of members in the family: SNO.]Name [Relation [Age [Gender |Martal |Wheth- [Source JIs [SHG Status |eream-|ofin- |SHG [ID ing? (Vi|come/ | mem- N) Occupa- | ber tion Screening (To be filled by Officials) Aptitude Test (Score) Allocated Trade ‘Comments if any Declaration: 235DDU-GKY 286 1 S/o /Wio/ Die. herebydeclare thatthe information provided above is true to the best of my knowledge & belief. If selected for training, | hereby undertake: ‘To attend and participate in all the sessions/classes of the aforesaid training program diligently; ‘Tomaintain discipline and follow the instructions of the trainer, while undergoing the said training program; ‘To successfully complete the training program; and understand that | will be deemed ineligible for assessment and certification unless, | fulfil the above criteria and meet the assessment standards. Signature of the candidate ‘The following documents are attached : 6 photos Document as proof of domicile (Ration Card or any other) Document as age proof PL Card or Certification by Panchayat Authority/ Job card (MNREGA)/ RSBY Card/ Antyodaya Anna Yojana Ration Card/ SHG certificate Proof of Sc/ST/OBC/ Minority/PWD, if applicable Signature of Applicant Selected for Training: Yes/No If no, reason for elimination: Signature of PIA Representative