Skill Development & Industrial Training Department, Haryana.
ITI admission form - 2025
Registration No - Ico25210002108210047
Personal Information
Candidate Name Harsh Date of Birth 27/05/2005
Family Id 2ujk7693 Member Id SRXXXXX
Gender Male Blood Group ---
Marital Status UnMarried Aadhaar No. XXXXXXXX0376
e-mail ak2776209@[Link] Mobile No. 7494858110
Mother's Name Suman Father's / Husband's Name Vinod
Mother Occupation Homemaker Father Occupation Others
Permanent Address [Link].0, Street 0, Landmark NANAK PURI COLONY, District KAITHAL , Kaithal , KAITHAL , HARYANA , 136027
Correspondence Address [Link].0, Street 0, Landmark NANAK PURI COLONY, District KAITHAL , Kaithal , KAITHAL , HARYANA , 136027
Telephone No. --- BPL Card No. ---
Religion Hinduism Nationality Indian
Country INDIA State HARYANA
District KAITHAL Block / Municipality Kaithal
Guardian Name Suman Guardian Mobile No.: --- Guardian e-mail: ---
Are you a Resident of Haryana or Yes Parental Income from all Sources More than Rs 2,50,000 and less than or equal
Domicile Holder of Haryana? to Rs 3,00,000
Education Qualification
Stream : 10th with Sci and Math
Exam Passed Univ /Board School /College Roll no Result Status Passing Year Marks obta/CGPA Max. Marks %tage
10th Haryana Open School Boar Haryana open scho 21082100 Pass 2021 170 500 34
d ol 47
Subject Wise Marks Detail of 10th
Subject Name Marks Obtained Maximum Marks
ENGLISH 33 100
MATHEMATICS 33 100
SCIENCE 33 100
Reservation Detail
Reservation Category Schedule Caste
Caste Category Scheduled Caste
Caste Chamar
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? Yes
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 Death Certificate of husband/father
Choice of Trade Preferences
Preference No. ITI Trade Trade Section
1 GITI Kaithal, REFRIGERATION AND AIR REFRIGERATION AND AIR CONDITIONING
KAITHAL CONDITIONING TECHNICIAN TECHNICIAN NCVT- Paid
2 GITI Kaithal, Mechanic (Motor Vehicle) Dual Mechanic (Motor Vehicle) Dual NCVT- Paid
KAITHAL
Fess Detail
Amount Tracking Id Bank Ref. No. Order Status Payment Mode Payment Date Transaction Id
50 113822236939 517649512558 success Unified Payments 2025-06- 000210821004725
25T17:48:34 062025174722466
(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: 16/07/2025 15:41:15