Industrial Training Institute (Pvt.) Rangia ,Registration Form

INDUSTRIAL TRAINING INSTITUTE (PVT.),RANGIA

Run by- Edutech Institute of Technology(Pvt.) ITI, Rangia

Affiliated to state Council of Vocational Training(SCVT),Govt. of India

Under Directorate of Employment & Craftsmen Training, Govt. of Assam

Registration Form

Select the Trade you are applying for *

1.Name of the Applicant : 2.Roll No. :

3.Father's Name : 9.Father's Occupation :

4.Father's Contact no : 5.Mother's Name :

6.Mother's Occupation : 7.Mother's Contact no :

8.Present Address : 9.Permanent Address :

10.Date of Birth
(According to H.S.L.C. admit Card*) :

11.Marks seeured in HSLC/Equivalent Examnation

Subject MIL/Alt. English G.Maths G.Science S.Science Elective-I Elective-II Total

Full Marks

Marks Secured

12. Marks seeured in H.S./Equivalent Examnation (If cleared)

Subject MIL/Alt. English Elective-I Elective-II Elective-III Total Elective-IV

Full Marks

Marks Secured

13. Phone No. 15.E-Mail :

14. Aadhar No 15.Category :

16. Are you from BPL? Yes NO 17. Academic Year

18. Family's Annual Income:
(Copy of Certificate issued by appropriate authority must be submitted during verification)*

19.Nationality : 20.Religion :

21. Community 22.Password
Show Password

Password must contain the following:

A lowercase letter

A capital (uppercase) letter

A number

Minimum 8 characters

Bank Account Details

A/C No. IFSC Code Name of Bank Branch Name of A/C holder

Possport size photo
(whatsapp image can not support)*
Signature
(whatsapp image can not support)*

1.Name of the Applicant :		2.Roll No. :
3.Father's Name :		9.Father's Occupation :
4.Father's Contact no :		5.Mother's Name :
6.Mother's Occupation :		7.Mother's Contact no :
8.Present Address :		9.Permanent Address :
10.Date of Birth (According to H.S.L.C. admit Card*) :

Subject	MIL/Alt.	English	G.Maths	G.Science	S.Science	Elective-I	Elective-II	Total
11.Marks seeured in HSLC/Equivalent Examnation
Full Marks
Marks Secured

Subject	MIL/Alt.	English	Elective-I	Elective-II	Elective-III	Total	Elective-IV
12. Marks seeured in H.S./Equivalent Examnation (If cleared)
Full Marks
Marks Secured

13. Phone No.		15.E-Mail :
14. Aadhar No		15.Category :
16. Are you from BPL?	Yes NO	17. Academic Year
18. Family's Annual Income: (Copy of Certificate issued by appropriate authority must be submitted during verification)*
19.Nationality :		20.Religion :
21. Community		22.Password	Show Password Password must contain the following: A lowercase letter A capital (uppercase) letter A number Minimum 8 characters