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Institute Code: 1414

Admission Form - 2018-2020

DUX PRIVATE INDUSTRIAL TRAINING INSTITUTE


PR09000902-Adarsh Private ITI ALLAHABAD
VILL+POST-BENDO , THANA+BLOCK- KARCHHANA
TAHSIL-KARCHHANA , DISTT-ALLAHABAD Pin : 212301
Ph: +91-8418043333, 8418834444, 7518915111, 7518916111
Web Site: http://www.adarshiti.org
E-Mail: adarshpiti1414@gmail.com


Trade



Fitter

Electrician

Mechanic Diesel Welder
(Please tick box in which Training applying for)

Paste a Pass Port size Photo


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d d - m m - y y y y

A. Indian
B. Others

A. Male
B. Female

A. General
D. Defence
B. SC
E. Physical Handicapped
C. ST
F. OBC

I hereby solemnly and sincerely affirm that I fulfill the eligibility conditions prescribed by the NCVT, New Delhi and that statements made and information furnished by me in this application form are true and correct. Also I have not withheld any information. If it is found that any information furnished herein is fraudulent, incorrect or untrue in material particulars, I realize that I am liable to be rejected prosecution and that the admission to the programme is liable to be cancelled. I agree to abide by the rulers, terms and regulations as contained in the information bulletin and others provisions notified by the NCVT. I am also aware that my admission shall be provisional and is subject to verification of my eligibility. I further declare that during my entire programme in the NCVT. I will not indulge in ragging and other activities, which are harmful for the institution.ss


Date: ...../...../............
Signature of the candidate ............................

I have carefully read and verified the information furnished by my son/daughter/ward and affirm that it is true and correct and he/she fulfils the eligibility conditions as mentioned in the information bulletin.


Date: ...../...../............
Signature of the Guardian ............................

The admission shall be strictly on merit basis subject to conduct and availability of seats in campus.


Details of Examination Passed (Starting from 10 th Class):


Sr. No. Examination Passed Board/University Year of Passing Division % of marks Taken Subjects
1.
2.
3.
4.

I hereby certify that the information furnished by Mr./Ms./Mrs. …………………………… is correct as per school/college records/testimonials produced before me.


Encl:

1.
2.
3.
4.

Date & Place: ....................
Signature of Principal ............................