TOOL ROOM &TRAINING CENTER

(An Extension center of Indo Danish Tool Room, Jamshedpur)

Course Applied For
Course Commencing date
Timing
Name of the Applicant
(In Capital letters)
Patliputra Industrial Area, Patna -800013
Application Form For short Term Course
ISO 29990: 2010
(F/TRTC/TRG/AF)
For Office Use Only
: Reg. NO
:
: Between 6.00 am to 10.00 pm (Monday to Saturday)
:

Father’s Name :
(In Capital letters)
Father’s Occupation :
Date of Birth (DD/MM/YY) : Affix a recent
Passport Size
Category (SC/ST/OBC/GEN) SC ST: OBC GEN PH
Sex (M/F) : Minority SHG……….Others Photograph
Phone / Mobile No. :
E-mail ID :
Whether Sponsored (Yes/No):
Name of the Sponsoring Authority :
(If Sponsored)
Whether required hostel (Yes/No) :
How did you come to know
about this course :
Postal Address (In Capital)
CORRESPONDENCE ADDRESS PERMANENT ADDRESS

PIN : PIN :
Educational Qualification/Other Professional Qualification/Training Courses etc:
Sl.No Exam Passed Year of Duration of the Board/ % age of Branch/
Passing Degree/Diploma University Marks Specialization

Experience (if any):

Enclosed Cash (Money receipt No.) / Draft
No. __________________________ Dated _____________________ for Rs. ____________________________
On (Bank) ________________________________ Drawn in favour of indo – Danish Tool Room.
Payable at Jamshedpur.
Declaration: I do hereby that the above information are true & I shall abide by the rules & regulations of the
institute.
Date: ……………………………………….Place : ……………………………………….
Note: 1) Please attach attested copies of final / pre – final year Mark Sheet.

Signature of Admission (I / C) Signature of Candidate