|STATE COUNCIL OF DIPLOMA IN MLT & MRT, ODISHA

APPLICATION FOR REGISTRATION UNDER DMLT/DMRT COUNCIL,ODISHA

First keep ready the Scan copy of Documents mentioned against (a) (b) (c) or (d) in .jpg / .jpeg Formats and then fill up the details
information as mentioned below
* Minimum Requirements
(a) Require amount of Challan paid through SBI e-Pay / SBI Collect through Online Mode Only (No Bank Draft will be accepted) *
(b) Scan copy of passport size colour photograph (4.5cm x 5 cm pixel 150 less than 50 KB) and Scan copy of Signature (6 x 1.5 cm 250 pixel 20KB) *
(c) Scan copy of Pass out certificate of DMLT/DMRT and Internship Completion Cert with CLC / TSLC last attended (For New/Fresh Registration)*
(d) Scan Copy Existing Registration Certificate and Pass out certificate of DMLT/DMRT (For Renewal Registration/Duplicate Registrationss )*

Please Fill up the Following Information to apply for Fresh Registration / Renewal of Registration/ Duplicate
Registration under DMLT/DMRTCouncil, Odisha

Please select the type of Registration *

Select Registartion Type
(Fresh/Renewal/Duplicate etc)

Please select the Course you have passed out * Select

Please enter Aadhar Number

Please select the Year of passing of the Course * Select

Please select the Name of the Institution from which

you have passed out *

If select others ,please enter the Institute Name

Enter SBI e-Pay / SBI Collect Reference No (DUXX)*

(If there is no such refernce number,

Enter SBI Bank Reference No (IGXXX)*
write same DUB number here)

Please enter the Amount Paid (INR) *

Please enter the Date of Payment * (DD/MM/YYYY)

Enter your Full Name (As per 10th certificate) *

Enter your Father Name (As per 10th certificate)*

Enter your Mother's Name

Date of Birth (As per 10th certificate) * (Select from the Calender)

Gender / Sex * Select

Please enter your Address Details *

(At-Po-PS-Via-Dt-Pin)

Please enter your Contact Valid Mobile No *

Please enter your valid e-mail ID *

Examination held in the Month, Year *

(like June 2018)
(As mentioned in Pass Certificate or Regd. Cert)
Duration of the Course (From)/ Date of admision /
(DD/MM/YYYY)
Joining in the Training *
Duration of the Course (To)/ Date of Completion /
(DD/MM/YYYY)
Relieving from the Training *
Roll no issued by DMLT/DMRT Board
(For New / Fresh Registration)
Existing Registration Number given by Board
(For Renewal / Duplicate Regd. only )
Existing Registration Date
(DD/MM/YYYY)
(For Renewal / Duplicate Regd. only )
Existing Registration Validity Till
(DD/MM/YYYY)
(For Renewal / Duplicate Regd. only )

Name of the Examining Body / Board / University *

Date of declaration of the Result (As per certificate) (DD/MM/YYYY)

Choose File no file selected

Upload your Signature *
(Scan Copy of Full SIgnature size 6 cm x 1.5 cm)

Choose File no file selected

Upload your photo *

(Scan Passport colour photo size 4.5 cm x 5 cm)

Choose File no file selected

Upload Scan Copy of Passout Certificate *

(For New / Renewal / Duplicate Registration only)

Choose File no file selected

Upload Scan copy of Internship & CLC/TSLC *

(For New Registrations) or Existing Registratioon
Certificate (For Renewal / Duplicate Registrations)

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