Skill Development & Industrial Training Department, Haryana.
ITI admission form - 2025
Registration No - ICA25082207576938
Personal Information
Candidate Name RAKESH KUMAR Date of Birth 04/03/1992
Family Id 7YDA7252 Member Id ECXXXXX
Gender Male Blood Group A+
Marital Status Married Aadhaar No. XXXXXXXX8088
e-mail sanjusyoran@[Link] Mobile No. 9728097878
Mother's Name SUNITA RANI Father's / Husband's Name MAHENDER SINGH
Mother Occupation Homemaker Father Occupation Unemployed
Permanent Address [Link].91, Street Near Chaupal, Landmark Parwala, District KARNAL , NILOKHERI BL , KARNAL , HARYANA , 132116
Correspondence Address [Link].91, Street Near Chaupal, Landmark Parwala, District KARNAL , NILOKHERI BL , KARNAL , HARYANA , 132116
Telephone No. --- BPL Card No. ---
Religion Hinduism Nationality Indian
Country INDIA State HARYANA
District KARNAL Block / Municipality NILOKHERI BL
Guardian Name --- Guardian Mobile No.: --- Guardian e-mail: ---
Are you a Resident of Haryana or Yes Parental Income from all Sources Less than or equal to Rs 50,000
Domicile Holder of Haryana?
Education Qualification
Stream : 10th with Sci and Math
Exam Result Passing Marks Max. %tag
Passed Univ /Board School /College Roll no Status Year obta/CGPA Marks e
10th Haryana Board of School Ed GOVT HIGH SCHOOL RAMANA R 2207576 Pass 2008 267 500 53.4
ucation AMANI 938
Subject Wise Marks Detail of 10th
Subject Name Marks Obtained Maximum Marks
ENGLISH 57 100
MATHEMATICS 50 100
SCIENCE 51 100
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? 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
Preference No. ITI Trade Trade Section
1 GITI Taraori, KARNAL Electrician Electrician NCVT
2 GITI Nissing, KARNAL Electrician Electrician NCVT
Fess Detail
Amount Tracking Id Bank Ref. No. Order Status Payment Mode Payment Date Transaction Id
50 113814950066 517172862763 success Unified Payments 2025-06- 508220757693820
20T13:03:13 062025130203818
(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: 20/06/2025 13:08:19