GOVT ITI KAKINADA

STUDENT DETAILS FORM

***AS PER SSC CERTIFICATE FILL BELOW DETAILS***

STUDENT NAME : _______________________________________

FATHER NAME : _______________________________________

MOTHER NAME : _______________________________________

DATE OF BIRTH : __________________________

MOLE-1
MOLE-2

STUDENT AADHAAR NO :

FATHER AADHAAR NO :

MOTHER AADHAAR NO :

STUDENT PARMENENT PHONE NO :

STUDENT ADHAAR LINKED PHONE NO :

FATHER PHONE NO :

MOTHER PHONE NO :

STUDENT PARMENENT EMAIL ID : ____________________________________________

CAST : SUB CAST :

SSC 10TH DETAILS :-

HALLTICKET NO : ___________________________ PASS YEAR : _____________

PASS TYPE : _____________________________ GPA /MARKS : _____________

COLLEGE ADMISSION NUMBER COLLAGE ADMISSION DATE

STATE :

DISTRICT :

MANDAL :

VILLAGE :

SECRETARIAT NAME :

SECRETARIAT NUMBER :

STUDENT ADRESS : -

H.NO/DOOR NO :

LAND MARK- STREET :

PIN CODE :

CASTE CERTIFICATE NO :

INCOME CERTIFICATE NO :

BANK JOINT ACCOUNT NO:

IFSC CODE :

STUDENT SIGNATURE PARENT’S SIGNATURE

 *** STUDENT SUBMESION DOCUMENTS ***

1) SSC MARKS MEMO – 6 COPYS

2) STUDENT AADHAAR CARD – 6 COPYS
3) FATHER AADHAAR CARD – 6 COPYS
4) MOTHER AADHAAR CARD – 6 COPYS
5) CASTE / EWS CERTIFICATE – 2 COPYS
6) INCOME CERTIFICATE – 2 COPYS
7) RATION CARD – 2 COPYS
8) JOINT BANK ACCOUNT (STUDENT + MOTHER ) – 2 COPYS
9) STUDENT PASSPORT SIZE WITH UNIFORM – 6 COPYS