Skill Development & Industrial Training Department, Haryana.

ITI admission form - 2026

Registration No - ICA26263026259479

Personal Information

Candidate Name KARTIK Date of Birth 12/05/2009

Family Id 1RTY9457 Member Id KXXXXXX

Gender Male Blood Group Not Known

Marital Status UnMarried Aadhaar No. XXXXXXXX9240

e-mail k40985612@[Link] Mobile No. 8684095805

Mother's Name GEETA Father's / Husband's Name HIRA LAL

Mother Occupation Homemaker Father Occupation Other labour

Permanent Address [Link], Street NULL, Landmark SHAMNAGAR, District REWARI , NAHAR BL , REWARI , HARYANA , 123303
Correspondence Address [Link], Street NULL, Landmark SHAMNAGAR, District REWARI , NAHAR BL , REWARI , HARYANA , 123303
Telephone No. --- BPL Card No. ---
Religion Hinduism Nationality Indian
Country INDIA State HARYANA

District REWARI Block / Municipality NAHAR BL

Guardian Name --- Guardian Mobile No.: --- Guardian e-mail: ---
Are you a Resident of Haryana or Domicile Holder of Yes Parental Income from all Sources More than Rs 50,000 and less than or equal to Rs 1,00,000
Haryana?

Education Qualification

Stream : 12th
Exam Passed Univ /Board School /College Roll no Result Status Passing Year Marks obta/CGPA Max. Marks %tage
12th Haryana Board of School Education GOVT SR SEC SCHOOL KRISHAN NAGAR 3026259479 Pass 2026 370 500 74

10th Haryana Board of School Education GOVT SR SEC SCHOOL KRISHAN NAGAR 1024315008 Pass 2024 332 500 66.4

Subject Wise Marks Detail of 10th

Subject Name Marks Obtained Maximum Marks

ENGLISH 51 100

MATHEMATICS 66 100

SCIENCE 54 100

Reservation Detail

Reservation Category Schedule Caste

Caste Category Deprived Scheduled Caste

Caste Dhanak

Divyang Category ---

1. Are you a Resident of Haryana Yes

OR
Do you have Completed 10th class from a school situated in Haryana?

2. Are you from Minority Community? No

Weightage Detail

1 Are you a widow or ward of widow? No

2 Are you Orphan? No

3 Are you Applying for Gram Panchayat Weightage? No

Gram Panchayat ---

Documents Attached

[Link] Document Name

1 Matric (10th Class)

2 Senior Secondary (12th Class)

3 SC/DSC Certificate

Choice of Trade Preferences

Preference No. ITI Trade Trade Section

1 GITI Kosli, REWARI Electrician Electrician NCVT

2 GITI Kosli, REWARI Fire Technology and Industrial Safety Management Fire Technology and Industrial Safety Management SCVT

Fess Detail

Amount Tracking Id Bank Ref. No. Order Status Payment Mode Payment Date Transaction Id

50 114555943337 652177911134 success Unified Payments 2026-06-04T17:32:42 626302625947904062026173243354

(I solemnly declare that the above information is absolutely true to the best of my knowledge and belief. I also know that if any detail
given in my application form are found to be false then my admission will be cancelled. I am aware of the fact that I have to timely
deposit fees and other dues in the institute. I have to follow proper discipline of the institute. I will have to take due care of tools/
equipments issued to me and I will not leave the course till its completion.
I further admit that if I do not follow the above instructions then the institution has the authority to recover the amount spent on my
training or any suitable amount decided by institute).
मैं प्रमाणित करता/ करती हूँ की उपरोक्त दी गई सूचना मेरी जानकारी तथा विश्वास के अनुसार बिलकु ल सत्य है I मैं ये भी जानता/ जानती हूँ कि यदि आवेदन
पत्र मे कोई विवरण असत्य पाया गया तो मेरा प्रवेश रद्द कर दिया जाएगा I मैं इस बात से परिचित हूँ की मुझे संस्थान में फीस व अन्य राशि जमा करवाने और
मुझे प्रशिक्षण संस्थान/ कें द्र के अनुशासन के अनुकू ल चलना होगा और उन औजारों का जो मेरे पास होंगे मुझे उनका पूरा-पूरा ध्यान रखना होगा और मैं अपने
प्रशिक्षण समाप्त होने तक कोर्स नहीं छोडूंगा/ छोडूंगी |
मैं आगे स्वीकार करता/ करती हूँ की यदि मैं उपरोक्त वचन का पालन नहीं करूँ गा/ करुँ गी तो संस्थान का अधिकार होगा की मुझसे प्रशिक्षण पर व्यय की गई
रकम वसूल कर ले या ऐसी रकम जो संस्थान उचित समझेगी |

Student Signtaure
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