Application Form Aug. 2014-16 - Bokaro Ispat Educational Trust

Bokaro Pvt. Industrial Training Institute
C.I.S.F Campus, Bokaro Steel City
Jharkhand, Pin Code – 827001
Website: www.bietrust.org
Cash : Rs. 400/DD No. ___________________
Date: ___________________
APPLICATION FORM
Application No.
: BPITI/Aug., 2014 - _______
1. Name of Applicant
: ______________________________________________________________________
Affix a Colour
passport size
photograph
self attested
2. Father’s/Guardian’s Name : ______________________________________________________________________
3. Date of Birth
: (In Number) ___________________________________
(in words)
4. Sex
: _______________________________________________________________________________________________
: _______________
5. Category (Tick only)
Nationality
: ________________________
Contact No
: ___________________________
: (GEN / SC / ST / OBC / CISF Ward/Local Displaced)
6. Choice of Trade
(Mention preference – Fitter & Welder) : 1. _______________________________
2. __________________________________
7 A. Educational Qualification
Exam Passed
Year of
Passing
Board
Total
Marks
Marks
obtained
%age of
marks
% Science
% Maths
Class X
B. Candidates passing from CBSE 2012 & 2013 :
(CBSE board )
Exam
Passed
Year of
passing
X (AISSE)
Subjects
Grade
Point
* (P)
%age
(P x 9.5)
8. Address for correspondence
Eligibility
TRADE
(Both/Electrician/ None)
1. Fitter
2. Welder
3. Both
CGPA
Science:
Math:
*Grade (point) :
(For office use)
A1 (10), A2 (9), B1 (8), B2 (7), C1 (6), C2 (5), D (4)
: ______________________________________________________________________________________
_______________________________________________________________________________________________________________________________
9. E-mail ID (if any)
: _______________________________________________________________________________________________
Enclosures : I. _______________________________________________ II. _____________________________________________________________
III. ______________________________________________ IV. _____________________________________________________________
I hereby declare that particular furnished above are true to the best of my knowledge & belief.
Date : ___________________________
Applicant’s Signature
Acknowledgement
Affix a Colour
passport size
photograph
self attested
Application No.
Received Application No. BPITI/Aug.,2014 -_________ from Mr./Miss. ________________________________________________
for Admission in _________________________ Trade(s) in session 2014-16 of Bokaro Pvt. ITI.
Signature of Receiver with Seal
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