6/25/24, 11:54 AM Skill Development
Skill Development & Industrial Training Department, Haryana.
ITI admission form - 2024
Registration No - ICA24203020200276
Personal Information
Candidate Name AJAY KUMAR Date of Birth 14/11/2000
Family Id 6THT9993 Member Id RCXXXXX
Gender Male Blood Group B+
Marital Status UnMarried Aadhaar No. XXXXXXXX5622
e-mail rootuser782@[Link] Mobile No. 9992501320
Mother's Name REJHA DEVI Father's / Husband's Name ISHWAR SINGH
Mother Occupation Homemaker Father Occupation Construction worker
Permanent Address [Link].H NO 119B, Street BLOCK NO 7, Landmark UKLANA MANDI, District HISAR , Uklanamandi , HISAR ,
HARYANA , 125113
Correspondence Address [Link].H NO 119B, Street BLOCK NO 7, Landmark UKLANA MANDI, District HISAR , Uklanamandi , HISAR ,
HARYANA , 125113
Telephone No. --- BPL Card No. ---
Religion Hinduism Nationality Indian
Country INDIA State HARYANA
District HISAR Block / Municipality Uklanamandi
Guardian Name ISHWAR SINGH Guardian Mobile No.: 7404509200 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
Domicile Holder of Haryana? Rs 1,00,000
Education Qualification
Stream : 12th
Exam Result Passing Marks Max. %tag
Passed Univ /Board School /College Roll no Status Year obta/CGPA Marks e
12th Haryana Board of School E GOVT SR SEC SCHOOL UKLAN 3020200 Pass 2020 375 500 75
ducation A MANDI 276
10th Haryana Board of School E SHRI ADISHWAR JAIN HIGH SC 2018145 Pass 2018 382 500 76.4
ducation HOOL 929
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Subject Name Marks Obtained Maximum Marks
ENGLISH 71 100
MATHEMATICS 68 100
SCIENCE 56 100
Reservation Detail
Reservation Category Schedule Caste
Caste Category Deprived Scheduled Caste
Caste Balmiki
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 ---
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[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 Barwala, HISAR Draughtsman (Civil) Draughtsman (Civil) NCVT
2 GITI Tohana, Draughtsman (Civil) Draughtsman (Civil) NCVT
FATEHABAD
3 GITI Surewala, HISAR Draughtsman (Civil) Draughtsman (Civil) SCVT
4 GITI Barwala, HISAR Computer Operator and Programming Computer Operator and Programming Assistant
Assistant NCVT
5 GITI Surewala, HISAR Computer Operator and Programming Computer Operator and Programming Assistant
Assistant SCVT
6 GITI Hisar, HISAR Surveyor Surveyor NCVT
7 GITI Barwala, HISAR Draughtsman (Mechanical) Draughtsman (Mechanical) NCVT
8 GITI Surewala, HISAR Solar Technician (Electrical) Solar Technician (Electrical) SCVT
9 GITI Barwala, HISAR Fitter Fitter NCVT
10 GITI Barwala, HISAR Stenographer & Secretarial Assistant Stenographer & Secretarial Assistant (English)
(English) SCVT
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Amount Tracking Id Bank Ref. No. Order Status Payment Mode Payment Date Transaction Id
50 113345624986 250262 success Debit Card 2024-06- 420302020027625
25T11:41:22 062024114805400
(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: 25/06/2024 11:47:06
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