Skill Development & Industrial Training Department, Haryana.

ITI admission form - 2026

Registration No - ICB262600031602454

Personal Information

Candidate Name RAMAN Date of Birth 19/01/2009

Family Id 1ZBR6732 Member Id UNXXXXX

Gender Male Blood Group ---

Marital Status UnMarried Aadhaar No. XXXXXXXX8662

e-mail rkjangra532@[Link] Mobile No. 8607491926

Mother's Name SUMAN Father's / Husband's Name VIJENDER

Mother Occupation Homemaker Father Occupation Unorganised worker

Permanent Address [Link].148E, Street W NO 13 VIKASH NAGAR, Landmark VPO TOSHAM DISTT BHIWANI HARYANA 127040, District BHIWANI ,
TOSHAM BL , BHIWANI , HARYANA , 127040
Correspondence Address [Link].148E, Street W NO 13 VIKASH NAGAR, Landmark VPO TOSHAM DISTT BHIWANI HARYANA 127040, District BHIWANI ,
TOSHAM BL , BHIWANI , HARYANA , 127040
Telephone No. --- BPL Card No. ---
Religion Hinduism Nationality Indian

Country INDIA State HARYANA

District BHIWANI Block / Municipality TOSHAM BL
Guardian Name --- Guardian Mobile No.: 9992462555 Guardian e-mail: ---
Are you a Resident of Haryana or Yes Parental Income from all Sources More than Rs 50,000 and less than or equal to Rs
Domicile Holder of Haryana? 1,00,000

Education Qualification

Stream : 12th
Exam Roll Result Passing Marks Max.
Passed Univ /Board School /College no Status Year obta/CGPA Marks %tage
12th Central Board of Secondary Educati GOVT MODEL SKT S S SCH TOSHAM BHI 31602 Pass 2026 251 500 50.2
on(CBSE) WANI HRY 454
10th Central Board of Secondary Educati GOVT MODEL SKT S S SCH TOSHAM BHI 17110 Pass 2024 263 500 52.6
on(CBSE) WANI HRY 839
Subject Wise Marks Detail of 10th

Subject Name Marks Obtained Maximum Marks

ENGLISH 56 100

MATHEMATICS 38 100

SCIENCE 33 100

Reservation Detail

Reservation Category Backward Class

Caste Category Backward Class-A

Caste Khati

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)

Choice of Trade Preferences

Preference No. ITI Trade Trade Section

1 GITI Bhiwani, REFRIGERATION AND AIR CONDITIONING REFRIGERATION AND AIR CONDITIONING TECHNICIAN
BHIWANI TECHNICIAN NCVT

2 GITI Nalwa, HISAR Electronics Mechanic Electronics Mechanic SCVT

3 GITI Bhiwani, Electronics Mechanic Electronics Mechanic NCVT

BHIWANI

4 GITI Nalwa, HISAR Electrician Electrician NCVT

5 GITI Bhiwani, Electrician Electrician NCVT

BHIWANI

6 GITI Nalwa, HISAR Fitter Fitter SCVT

7 GITI Tosham, Fitter Fitter NCVT

BHIWANI

8 GITI Tosham, Electrician Electrician NCVT

BHIWANI
 Fess Detail

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

100 114553244725 615471432683 success Unified Payments 2026-06- 2600031602454030620

03T16:10:51 26161051457

(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
Form Submitted on: 03/07/2026 13:52:00