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Application Form

This document contains an application form for admission to a diploma program in 2016-17. The form requests personal details of the student such as name, date of birth, gender, category, nationality, and Aadhaar number. It also asks for educational details including board, year of passing/appearing for the qualifying exam, roll number, and school name. Finally, it collects contact information like address, email, phone numbers and includes a declaration that must be signed by the applicant and parent/guardian. Upon submission, a receipt will be provided with the applicant's name and date of receiving at the nodal center.

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harmannangal
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81 views1 page

Application Form

This document contains an application form for admission to a diploma program in 2016-17. The form requests personal details of the student such as name, date of birth, gender, category, nationality, and Aadhaar number. It also asks for educational details including board, year of passing/appearing for the qualifying exam, roll number, and school name. Finally, it collects contact information like address, email, phone numbers and includes a declaration that must be signed by the applicant and parent/guardian. Upon submission, a receipt will be provided with the applicant's name and date of receiving at the nodal center.

Uploaded by

harmannangal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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THE PUNJAB STATE BOARD OF TECHNICAL EDUCATION & INDUSTRIAL TRAINING

Plot No. 1-A, Sector 36-A, Chandigarh-160036

APPLICATION FORM FOR DIPLOMA - 2016-17


Sr.No.

(For Admission through On-line Counselling)

PERSONAL DETAIL
Students Name

___________________________________________

Fathers Name

___________________________________________

Mothers Name

___________________________________________

Date of Birth

DD

Gender

Male

Female

Category

SC/ST

Non-SC

Nationality

___________________________________________

MM

Paste here recent


passport size
photograph

YY
Transgender

Aadhaar No. (UID) (optional)


EDUCATIONAL DETAIL FOR QUALIFYING EXAM
Matriculation / 10th
Board

Appeared
Year of passing/
Appearing

Passed
Roll No.

School Name

CORRESPONDENCE DETAIL
Address

_______________________________________________________________
City/District ____________________________________________________
Post Office _____________________________________________________
State __________________________________ Pin code _______________

Email

_______________________________________________________________

Mobile

__________________Landline No. (with STD Code) ___________________

DECLARATION BY THE APPLICANT & HIS/HER FATHER/MOTHER/GUARDIAN


We hereby declare that all the particulars stated in the application are correct and true to the best of our knowledge. If any of the particular is found to be incorrect or untrue then candidature of the applicant may be cancelled.
Date

Sr.No.

Signature of the Applicant

Signature of Father/Guardian

RECEIPT

Application form of Sh. ______________________________ S/D/o Sh. ______________________________


has been received on _______________ at the nodal centre _____________________________________________.
Receiving Official
(Signature with seal)

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