Annexure-3

Application form for Accreditation from Quality Council of India

(Note: All the Details in the Application need to be filled based on availability of data on date of Application)

I. General Information
Application as (Please tick the appropriate Category):
A. New Industrial Training Institute

B. Existing Industrial Training Institute 

- Opening New Trade 
- Adding more Units in existing Trade
C. State: Madhya Pradesh

Name of the Institute: GOVERNMENT INDUSTRIAL TRAINING INSTITUTE SHAHGANJ

Postal Address: GOVERNMENT INDUSTRIAL TRAINING INSTITUTE, SHAHGANJ, TEHSIL- BUDNI, DISTRICT- SEHORE (M.P.)
(Indicate Taluka,
District Details along
WITH Pin Code)
Pin Code: 466554
Tel. No. (With STD Code): N/A Fax No. (With STD Code): N/A

Email Address: itishahganj@gmail.com Website: N/A

Last Update on: N/A

Principal Name: K S WARKADE

Mobile No.: 8989136386

 Rural  Urban Women Minority

Government  Private J&K North East

Is the Institute owned by Trust/ Society: No

Trust/ Society registered: -

Year of Registration: - Registration No.: -

Period up to which registration of Trust/ Society is valid: -

Is the Institute running Center of Excellence scheme: No

(Only in case of Government Institute)

D. Name of the organization: GOVERNMENT INDUSTRIAL TRAINING INSTITUTE, SHAHGANJ

(Seeking affiliation)

Postal Address: GOVERNMENT INDUSTRIAL TRAINING INSTITUTE, SHAHGANJ, TEHSIL- BUDNI, DISTRICT- SEHORE (M.P.)

Pin Code: 466554

Tel. No. (With STD Code): N/A Fax No. (with STD Code): N/A

Authorized Person: K S WARKADE

Mobile No.: 8989136386

E. Date of Establishment of the Institute: AUGUST 2011

In case of Existing ITI: DGET File Reference No.: -

F. Details of Any other NCVT affiliated ITI’s which are running under the same organization

Name of ITI Address
- -
- -
- -
DGET File Ref. No. Trade Name
- -
- -
- -
Number of Units Number of
students
- -
- -
- -

G. Is there a change of Premises: Yes No 

Reason or change of Premises: -

Is there shifting of Trade within the same ITI: Yes  No

Name of Trade Being Surrendered: 1. WELDER (GAS & ELECTRICAL) Units: 01

2. - Units: -

Name of the Trade being opened: 1. WELDER Units: 01

2. - Units: -

Reason for Shifting of Trade: Welder (Gas & Electrical) Trade is in SCVT curriculum, but not mentioned in list of NCVT curriculum.
II. (B) Trades and units or which affiliation is sought now:

No Admission is allowed in any NCVT Trade before affiliation is granted by NCVT Sub Committee

Sl No. Trades/Units for which affiliation Sought Session (Month & Year) From
Total Units = Which affiliation sought
Trades Units
(3+4+5)
1st Shift 2nd Shift 3rd Shift
1 2 3 4 5 6 7
01 Electrician 01 01 - 02 JULY 2016
02 Fitter 01 01 - 02 JULY 2016
03 Diesel Mechanic 01 - - 01 JULY 2016
04 Welder 01 - - 01 JULY 2016

II. (B) Modules and units under COE Scheme for which affiliation is sought now: NIL

Sl No. Modules/Units for which affiliation Sought Session (Month & Year) From
Total Units = Which affiliation sought
Modules Units
(3+4+5)
1st Shift 2nd Shift 3rd Shift
1 2 3 4 5 6 7
- - - - - - -
- - - - - - -
- - - - - - -
III (A). 1. Manpower

Sl Designation Name Fathers Name Date of Date of Photogra Voter ID Card

No. Joining Birth ph (U- No./Valid I Card
Institute (U-Upload)
Upload)
1 Principal/ Head of Institute - - - - - -
2 Vice – Principal/ Supdt. K S WARKADE B L WARKADE 03/03/2014 11/06/1971 TCP0626457
3 Training Officer/ Group Instructor
4 Instructor – Theory(ELECTRICIAN) SHAILENDRA TEEKARAM 30/11/2012 08/01/1989 LXZ2478667
AGARMORE AGARMORE
Instructor – Theory(ELECTRICIAN) PANKAJ PATEL RAMESH PATEL 16/09/2013 04/07/1987 ZLA2625184
Instructor – Theory(FITTER) DHRUV SINGH RAM SINGH 31/01/2013 25/01/1985 BSQ7426927
MOURY
Instructor – Theory(FITTER) RAVINDRA T R PATELIA 16/09/2013 20/09/1986 JHJ2357689
PATELIA
Instructor – Theory(WELDER) KAMLESH PATEL S P PATEL 17/07/2015 24/07/1989 WZA1835180
Instructor – Theory(MECHANIC RAHUL G R BARASKER 23/09/2015 21/09/1989 CYM1523273
DIESEL)(GUEST FACULTY) BARASKER
5 Instructor – Practical -DO-
6 Engineering Drawing Instructor BHUPENDRA NARENDRA 30/11/2012 22/04/1984
CHANDEKAR CHANDEKAR
7 Workshop Calculation and PREM LAL UIKEY GHANSHYAM 01/10/2015 20/12/1986 ABK0713513
Science Instructor(Mathematics UIKEY
Instructor) (GUEST FACULTY)
8 IT Lab Instructor N/A - - - - -
9 Employability skill Instructor N/A - - - - -
(Applicable where the seating
capacity is more than 1000
trainees in the Institute)
III. (A). 2. Administrative & Supporting Staff

Sl Designation Name Fathers Name Date of Joining Date of Photograph Voter ID Card
No. Institute Birth (U- No./Valid I Card
Upload) (U-Upload)
1 Accountant H C HANOTIYA 08/05/2013 20/04/1959
2 Clerk SANJAY THAKUR HARBHAJAN SINGH THAKUR 28/06/2013 26/01/1983 NRA0065458
 Name Secondary School/ Technical Qualifications {Degree/ Diploma, ITI, CTI} Branch year of Passing Certificate No. of Experience Details Salary Salary A/C Details Bank Name, Branch
Matric Year of enclosed certificate (Name of & A/C No. for the Staff Working since
Passing Certificate No. Establishment & Year last two years
of Experience)

Year of Certificate ITI CTI Diploma Degree 1 2 3 Bank A/C No. Branch
Passing Number Nam
(U-upload e
Copy of
certi.)
Year Certificate Year of Certificate Year of Certificate Year of Certificate Nam Post Yrs
of Number Passing Number Passing Number Passing Number e Held of
Passin (U-upload (U-upload (U-upload (U-upload Exp
g Copy of Copy of Copy of Copy of .
certi.) certi.) certi.) certi.)
K S WARKADE 1989 490581 1992 20822 2006 2601 - - - - TS 13 38450 SBI 30064132452 MANDLA
H C HANOTIYA ASSIT.
GRAD
-1
SHAILENDRA 2004 - - - - 2007 2012 TO 3 27000 SBI 30982315862 ITARSI
AGARMORE
PANKAJ PATEL TO 2 27000
DHRUV SINGH 2001 015188455 2007 07/01/3663 2014 ATI/MUM - - - - TO 3 27000 SBI 20008337460 GWALIOR
MOURY /CH-13-
14/0939
RAVINDRA 2003 03510496 2007 25612 - - - - - - TO 2 27000 SBI 32019854739 JABALPUR
PATELIYA
BHUPENDRA 2000 - - 2015 - - 2009 TO 3 27000 SBI 10794149623 BUDNI
CHANDEKAR
KAMLESH PATEL 2004 395537 - - - - - - 2012 08113060 TO 2 27000 PNB
SANJAY THAKUR 2002 02352386 - - - - 2009 9591 C.O. 2 6000 SBI 10900312140 BETUL
CUM-
CLERK
RAHUL 2005 5762188 - - - - 2010 0024828 2013 3650370 TO 2 10,000 SBI 31023299593 BETUL
BARASKER
PREM LAL UIKEY 2004 046331692 - - - - 2009 0036540 2013 3694802 TO 2 10,000 BOI 901410510001 SHAHGANJ
916
IV. (A) INFRASTRUCTURE

Details of Land & Building at the Institute: (Note: All Dimensions on the Drawing to be prepared by registered Architect should be in
MKS system.)- For details please refer Annexure G1

1. Total land area available for the institute as indicated in registration paper/relevant
documents.
2. Whether own or rented building (enclose proof of ownership/ lease deed/rent OWNED
agreement (Upload)
3. Date of occupation 12/12/2015

4. Duration of Lease/ rent agreement --

5. Date of expiry of lease/ rent agreement --

6. Site plan and lay-out of the entire institute (Upload) Attached

7. Name of Architect

8. Registration Number of Architect (Upload copy of building layout duly signed by

Architect)

Note: - Layout of Institute should clearly indicate the workshop for all trade/units/modules, class rooms, I.T. Lab, Principal Room, Drawing
Room (if required) etc. with its dimensions in MKS System.

IV (B). Area available in the Workshops (For details please refer Annexure G2):
 Name of the Maximum no. of units in one WORKSHOP
Trade/Module shift only
Required as per NCVT norms (Sq. M) Actually available (Sq M)
Electrician 01 98
Fitter 01 88
Diesel Mechanic 01 210 (Including Parking Area)
Welder 01 80
(Note: Upload front view of Institute, Classrooms photographs, Workshop photographs)
- Number of Floors in the Institute: - 02
- Workshops Roof ( Please tick the appropriate category): - Pitched Roof ( )/ Flat RCC Roof ( √ )
- No. of Washrooms in Institute: - 08
IV (C) POWER SUPPLY (For Details please refer Annex G3):
1. Electrical Connection issued in the name of (i) For existing institute: electricity bill indicating connected load is
2. Electrical Connection issuing authority required to be produced (details of existing trades, units should
3. Date o Connection also form part of the inspection report to assess the required
electrical load. (upload Electricity Bill Indicating connection load)
4. Whether three phase connection
(ii) For new institute: Installation report/ Meter sealing report
5. K. No. of the Connection indicating sanctioned load or if meter sealing report does not have
6. Meter Seal No. sanctioned load, copy of the sanctioned load, proof of payment of
7. Trade (Existing) : N/A Maxi no. of units Power supply required dues for the same along with meter sealing report should be
Trade (New): 04 in one shift as per norms in kW produced/ submitted.
Electrician 01 5.2 (for 2 units in 1 shift) (Upload relevant documents)
Fitter 01 3.51 (iii) where the institute is in the rented/leased building, the electric
connection should be in the name of the owner of the institute/
Diesel Mechanic 01 4.8
management agreement between landlord and the institute/
Welder 01 16 management/ society as the case may be, should be produced
Total electrical Load 19.51 along with the current bill (Upload)
Power supply available in the Institute (iv)Declaration by the owner of the institute that the sanction load
is for ITI only / shared with any other. (Upload)
IV. (D) TOOL, EQUIPMENT & MACHINARIES
(Note: Only new tools, Equipment and machinery to be purchased for new trade /expansion of trade / module wise/ sector wise in case of COE
scheme are required to be given in the following format in the standard tool list available in the syllabus of each trade / module (COE and
available on the DGET website –http//dget.nic.in/welcome/cts/tradeslist.html and www.dget.nic.in /http:// dget.nic.in/coe/welcome.html

S Name of the tools, equipment & Number of tools, Total no of tools Total no of tools & Total no Cost of the tool,
No machinery as per syllabus equipment & and equipment equipment required actually equipments &
machinery required required for the for the total units available for machinery with
for instructor & total units for which affiliation all the units Bill no and
trainees for one unit already affiliated is sought supplier details
as per NCVT norms
syllabus
1 2 3 4 5 6 7

IV (E) Tool, equipment and machineries (General machineries costing above Rs. 10,000)(Please submit the information trade wise/module
wise.)
S Name of the Make Year of Purchased Bill no ( Bill date Vat no Tin no Identification Photograph
No tools, manufacturing from ie copy of bill no punched with
equipment & supplier to be (Yes /No) principal
machinery as address along uploaded) (upload)
per syllabus with tel no
Additional Information Required From Existing Affiliated Institute
I. Whether previously granted affiliation in any trade/module:- NO
If so, particulars to be given as under: N/A
S No. Trade/ Trade/Module/Units Total Total Month DGE&T reference Remarks
Module Units no. of & Year which affiliation
Units (3+5+7) Trainees of Start granted with date
on Roll of (State/UT/Directorate’
(4+6+8) Session s ref/No. Not be
quoted)
1st No. of 2nd No. of 3rd No. of
shift trainees shift trainees shift trainees
on Roll on Roll on Roll
1 2 3 4 5 6 7 8 9 10 11
- - - - - - - - - - - - -

II. STANDARD OF TRAINING

a. ADMISSION (only for the trade (s) already affiliated to NCVT
(No admission is allowed in any NCVT trade before affiliation is granted by NCVT Sub-Committee)

b. Whether Placement Cell is available Yes √ No

Name of In-charge of placement cell

Contact no. (With STD code)

Mobile no.

Email id:
III Upload the copy of Quality System Manual

Declaration
We have carefully read and understand all NABET criteria for accreditation of Government and Private Industrial Training institute
seeking NCVT affiliation. The conformity with requirements of the accreditation criteria i.e. eligibility of staff, infrastructure,
machines, tools, and equipments etc has been verified by us at our end. We confirm that the information provided in support of this
application is correct to the best of our knowledge and belief.

We authorize NABET to make any enquiry as deemed fit as part of the reviewing process. We understand that in case any
information is found to be incorrect, it may result in rejection of this application and/or disqualification. We authorize NABET to
utilize the information provided in this application for legal, research, training, sharing with DGE&T and peer international members
and/or for any other purpose as may be deemed fit by NABET.

If accredited, we commit to notify NABET immediately of any changes in the status where information regarding such changes, if
declared may affect the consideration for accreditation of the institute.

Signature
Name (Authorized Signatory)
Designation
Institute Name
Date