14/06/2026, 20:19 Skill Development

Skill Development & Industrial Training Department, Haryana.

ITI admission form - 2026
Registration No - ICA26241024199771

Personal Information

Candidate Name YOGESH JOSHI Date of Birth 20/12/2006

Family Id 5FPW2668 Member Id BNXXXXX

Gender Male Blood Group ---

Marital Status UnMarried Aadhaar No. XXXXXXXX1521

e-mail khushwanticar@[Link] Mobile No. 8950090666

Mother's Name RANI Father's / Husband's Name RAJ GOPAL

Mother Occupation Homemaker Father Occupation Other labour

Permanent Address [Link].00, Street 00, Landmark VPO CHIRAO, District KARNAL , KARNAL , HARYANA , 132001

Correspondence Address [Link].00, Street 00, Landmark VPO CHIRAO, District KARNAL , KARNAL , HARYANA , 132001
Telephone No. --- BPL Card No. ---
Religion Hinduism Nationality Indian
Country INDIA State HARYANA

District KARNAL Block / Municipality ---

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

Education Qualification

Stream : 10th with Sci and Math

Exam Result Passing Marks Max.
Passed Univ /Board School /College Roll no Status Year obta/CGPA Marks %tage

10th Haryana Board of School E GOVT SR SEC SCHOOL, 1024199 Pass 2024 286 500 57.2
ducation CHIRAO 771

Subject Wise Marks Detail of 10th

Subject Name Marks Obtained Maximum Marks

SCIENCE 52 100

ENGLISH 49 100

MATHEMATICS 52 100

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Reservation Detail

Reservation Category General

Caste Category General

Caste General

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)

Choice of Trade Preferences

[Link] [Link] [Link] [Link] [Link] Document Name Document Name

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Fess Detail

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

100 114580242758 653195175239 success Unified Payments 2026-06- 624102419977114

14T20:17:33 062026201734972

(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: 14/06/2026 20:19:48

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