9/3/2020 PaymentForm

(ITP Web Registration Acknowledgment Form - Print in Portrait format on A4 size paper)

NSR Basic Membership

Date: 03/09/2020

TIN NO: ACK NO. 128003863N

Name of
Applicant
:Mr KONDEPATI SAI BHARATH

State for GST

calculation
:ANDHRA PRADESH Please affix your latest
Photograph

Date of Birth :09-Jul-1998

Mode of Payment
:Payment to POS (र 472.0) Please pay exact amount in
cash to the POS office

Employer Name :--

Employee
Number
:-- Signature
(Please sign in the centre of the box)

Valid Up To Date :23/10/2020

Note :
* To complete your registration please visit any Point of Service (POS) office. If you do not complete your registration within
50 days of issuance of Acknowledgement Number, your data will be purged from the system.
* You need to take print-out of this form to the POS along-with ORIGINAL proof of Photo Identity [Voter's Id
card/Passport/Driving License/Bank Pass Book (with Photo)/College ID card (not more than 4 years old)/PAN
card/Employment Identity Card].
* NSR registration fee is subject to change as per GST requirement.
* I have read, understood and I agree to the terms and conditions available on NSR website
https:\\nationalskillsregistry.com relating to my joining and using NSR and I agree to the same.

ACKNOWLEDGEMENT SLIP(For the use of POS only)

NSR Basic Membership
TIN NO : Ack No : 128003863N
Name of Applicant : Mr KONDEPATI SAI BHARATH POS ID :
Received the Application form for Registration as Knowledge Professional (KP) in the National Skills Registry.
Payment Mode only for NSR registration of KP:
(Please affix stamp, signature and date on correct option)
Received Cash from KP Received DD Payment not collected
Dated : _______
Rs.472.0 Drawn on : __________ Payment to be collected from company
Rs. : _____

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