GOVERNMENT OF MANIPUR

OFFICE OF THE PRINCIPAL A.C.T.CENTRE, THOUBAL.

To,
The....................................................................
.........................................................................

Application form for admission to Elementary/Advance/Short term course.

( To be filled up by the candidates in their own handwriting )

1. Name in full with surname:- .................................................................................................

2. Address in full village:- ..........................................................................................................
3. Father name/Guardians’ name:- ...........................................................................................
4. Education Qualification:- .......................................................................................................
5. Date of birth:- .......................................
6. Previous training passed.
Family trade or experience if any:- ...............................
7. Name of trade & course in which admission is sought:- ........................................................
8. Size of family:- .............Adults..................Minor..................
9. Annual Income of family:- ...................................................
10. Caste or community of the Candidates:- ......................................
11. Marital status of the Candidates:- ................................................
12. Name of the sponsoring society/Agency:- ....................................
13. Latest 2(two) passport size photograph .
14. Identity certificate (certified by a Gazetted officer).

UNDERTAKING
I will bide by the rules and regulation of the training centre I will be liable to refund the
amount of Stipend paid in case of any discontinuation of the training before completion of
its due course. I solemnly declare that the information’s furnished in this application are
true to the best of my knowledge and belief.

Signature of the candidate

.............................................
Postal Address: ............................................
Date of Application: ............................................

Signature of Father/Guardian