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Margdarshan Scheme- 2019

Registration Form for Summer Internship Programme

Personal Details
Name

Postal Address

Pin Code
City
Email
Mobile
Aadhaar No
Educational Details
B.Tech.

Higher Secondary

SSLC
Any other achievement

Internship Details
Duration of Internship
Area of interest
Advisor Preference
Bank Details
Bank Account Holder
Bank Name
Bank Account No
Bank IFSC code

Undertaking by the student


I will abide by the terms and conditions of National Institute of Technology, Tiruchirappalli during the
period of internship. I, hereby declare and confirm that the National Institute of Technology,
Tiruchirappalli shall not be held responsible in the event of any misfortune or accidents and/or
personal injuries whether fatal or otherwise.

Date Signature

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