SkillIndia RPL Trainee Registration Form

BANGLA

Basic Details:
Mr /Mrs /Ms First name Middle nane
KARSH
Last mame

Father's first name Father's middle name Father's last name

Mothers first name Mother's middle name Mother's last name

Guardin's first Hame Guardian's niddle n a m e gGuardian's last name

Relationship with Guardian Gender: M/E Date of Birth

Caste: ieneral/ SC ST/08C Religion Marital Status: Single Married/ Divorced

Bank Details:
Bank Naaie Branch Nane Accout Number

IES Code Account Holder's Full Name (As per PassBook)

Econouíeal Status Resldentat Statius

APL BPL Residential Non-Residential

Contact Details:
House No Road/Street Village/Town
State |District Biock/Municipality
|Post Office Police Station
G. Panchayet
PIN Code Email lD Mobile Number

Educational& Professional Qualification:

Educational QualifncationQualification Status Employment Status

Course& Training Details:

Training Type Sector Course

Documents
1)Aadhaar Card
Required:
2)Bank Passbook Front Page
3)Trainee Phatograph (1 Copy)
4)Residential Proof (Aadhaar Card/Voter Card/Ration Card)
5)Highest Qualification Proof
6)Age Proof
(SIGNATURE)