Candidate Registration Form

Centre Candidate ID : GJ01E81-0000687 Please tick to Confirm Correctness

Candidate Course Details:
Scheme: Pradhan Mantri Kaushal Vikas Date of Registration : 08 Jan 2019
Yojana 2.0
Training Type: Short Term Training
Sector: Iron and Steel
Sub-Sector: Iron and Steel
Job Role: Fitter: Leveling alignment
balancing
Where did you hear about Event/Workshop
the scheme?:
Conveyance and Boarding Conveyance
Preference?:
Candidate Identity Details:
Candidate Name: Vaghela Sachinbhai Type of Disability?: None
Narayanbhai Disability Category:
S/O Vaghela Narayanbhai UDID Card Number:
Gender: Male Education Attained : 9th to 10th
Year/Date of Birth: 10 Aug 1987 Category: SC
Aadhaar Number: XXXXXXXX3327 Religion: Hinduism
Aadhaar Verification Status: Successful Alternate ID Type:
Passport Number: Alternate ID No:
Passport Expiry Date: NPCI Bank Name:
Aadhaar Enrollment
Number:
Candidate's Aadhaar is not seeded to any bank account.
Please request the candidate to seed one of his / her bank accounts with Aadhaar Number by visiting the bank branch with Aadhaar
details.
Candidates not having a valid bank account are requested to open an account with a bank and seed it with Aadhaar.Such
candidates can continue with the Enrolment and Training.

Please inform the candidate that his / her reward money and other payments due to the candidate will only be transferred to his /
her Aadhaar seeded bank account.
Candidate Contact Details:
Address: 80 feet road,saktinandan Mobile Number: 7284008989
society,surendranagar, Landline Number:
SURENDRANAGAR,
Surendranagar Station Road S.O,
Wadhwan, Surendranagar,
Gujarat. Pincode- 363002
E-mail ID: vafhrlasachinm46@gmail.com
Candidate Bank Account Details:
Name as in bank: IFSC Code:
Bank Account Number: Bank Name:
In case of providing Alternate ID (i.e. any ID apart from Aadhaar), I confirm that the SPIA / TC has informed me that the reward money and other payments
due to me will only be transferred to the bank account provided above.

If I have not provided any bank details I will not claim any payments due to me at a later stage.
Candidate TC details:
TC Name: PMKK SURENDRANAGAR Address: 3rd Floor, Planet Square - 3, 80 ft
TC ID: 7809 Road, Surendranagar, Gujarat,
Partner Name: ICA EDU SKILLS PVT LTD Surendranagar, Surendranagar,
Gujarat, Surendranagar Gujarat
363642
Declaration:
I agree that my Aadhaar Number will be shared with National Payments Corporation of India (NPCI) for verifying if the Aadhaar Number is seeded with a
Bank.
I confirm that the TC / SPIA has informed me that my reward money and other payments due to me will only be transferred to my Aadhaar seeded bank
account.
In case of providing Alternate ID (i.e. any ID apart from Aadhaar), I confirm that the SPIA / TC has informed me that the reward money and other payments
due to me will only be transferred to the bank account provided in section “Candidate Bank Account Details” above.
If I have not provided any bank details I will not claim any payments due to me at a later stage.

Candidate’s Signature
For Training Centre Use:
SDMS Candidate ID:

Authorized Signatory

Designed & Delivered by Campus Management International