Office Industrial Training
Resume:
Government of Bihar
Bihar Combined Entrance Competitive Examination Board
Online Application Form for admission in the Professional Trades / Courses for session 2017-2018 of the Industrial Training Institute of Govt. of Bihar. Registration No.
3059596
Application Form No.
(For Office use only)
PART A
1. District in which ITI's of your
choice are situated:
BEGUSARAI - (34)
2. Name of Candidate: DEEPAK KUMAR
3. Father's Name: SHRINARAYAN DAS
4. Mother's Name: PYARI DEVI
5. Date of Birth: 12-01-1998
6. Gender: MALE
7. Reservation Category: SC
8. Disabled Quota: NO
9. Mobile No.: 829-***-****
10. Email ID: *****************@*****.***
11. Marks of identification: A MOLE ON THE RIGHT EYEVRO Note: Please Affix your same photo and put your full signature in English and Hindi in spaces provided above 12. Are You Permanent Resident of Bihar?: YES
13. Residential Eligibility: म त / पत / प त बह र क थ य / मल नव स ह 14. District for which residential certificate is obtained: BEGUSARAI - (34) 15. District of institute of passing/appearing in Matric /Equivalent exam.: BEGUSARAI - (34) 16. District where your father/mother is employed and for which employer's certificate is obtained:
BEGUSARAI - (34)
17. Do you claim Land Donner Quota for ITI Marhowrah?: N/A 18 (i). Do you claim SMQ Quota: NO
18 (ii). If yes, are you Son / Unmarried Daughter of Military Personnel: N/A 19. Educational Qualification: Matric / Equivalent PASSED 20. Percentage of marks obtained in Matric / Equivalent, if Passed: 63.60 21. Payment Details:
Branch Name Journal No. / Transaction No. Deposite Date Amount (in Rs.) Bill Desk IUR25254947643 03-04-2017 Rs. One Hundred Only ITICAT-2017
Registration No: 3059596 Security Code: E6CBE7 Page: 1 of 2 (PART A) 22. Address Details:
A. Permanent Address:
AT-KOLHUWARA GACHHI TOLA
POST-TEGHRA
PS-TEGHRA
District: BEGUSARAI
State: BIHAR Pin Code: 851133
B. Correspondence Address:
AT-KOLHUWARA GACHHI TOLA
POST-TEGHRA
PS-TEGHRA
District: BEGUSARAI
State: BIHAR Pin Code: 851133
Declaration by the Candidate: I DEEPAK KUMAR declare that information furnished above are correct and I shall forfeit my candidature and will be liable for legal action in case of any of them is proved to be false at any stage inclusive of admission or thereafter. Date:
Place: (Signature in English) (Signature in Hindi) ITICAT-2017
Registration No: 3059596 Security Code: 6B73B9 Page: 2 of 2 (PART A) Government of Bihar
Bihar Combined Entrance Competitive Examination Board Online Application Form for admission in the Professional Trades / Courses for session 2017-2018 of the Industrial Training Institute of Govt. of Bihar. Registration No.
3059596
Application Form No.
(For Office use only)
PART B
(For Office use only)
Selected for admission (First Counselling)
Against Roll No. Reservation Category Merit Serial at institution) in Trades /Courses)
Signature of
the Candidate
(At the time of
Counselling)
Signature of
the
verifying
Officer
ITICAT-2017
Controller of
Examination
BCECEB
Date:
Selected for admission (Second Counselling)
Against Roll No. Reservation Category Merit Serial at institution) in Trades /Courses)
Signature of
the Candidate
(At the time of
Counselling)
Signature of
the
verifying
Officer
ITICAT-2017
Controller of
Examination
BCECEB
Date:
Selected for admission (Third Counselling)
Against Roll No. Reservation Category Merit Serial at institution) in Trades /Courses)
Signature of
the Candidate
(At the time of
Counselling)
Signature of
the
verifying
Officer
ITICAT-2017
Controller of
Examination
BCECEB
Date:
1. District in which ITI's of your
choice are situated:
BEGUSARAI - (34)
2. Name of Candidate: DEEPAK KUMAR
3. Father's Name: SHRINARAYAN DAS
4. Mother's Name: PYARI DEVI
5. Date of Birth: 12-01-1998
6. Gender: MALE
7. Reservation Category: SC
8. Disabled Quota: NO
9. Mobile No.: 829-***-****
10. Email ID: *****************@*****.***
11. Marks of identification: A MOLE ON THE RIGHT EYEVRO Note: Please Affix your same photo and put your full signature in English and Hindi in spaces provided above 12. Are You Permanent Resident of Bihar?: YES
13. Residential Eligibility: म त / पत / प त बह र क थ य / मल नव स ह 14. District for which residential certificate is obtained: BEGUSARAI - (34) 15. District of institute of passing/appearing in Matric /Equivalent exam.: BEGUSARAI - (34) ITICAT-2017
Registration No: 3059596 Security Code: 57F598 Page: 1 of 3 (PART B) 16. District where your father/mother is employed and for which employer's certificate is obtained: BEGUSARAI - (34) 17. Do you claim Land Donner Quota for ITI Marhowrah?: N/A 18 (i). Do you claim SMQ Quota: NO
18 (ii). If yes, are you Son / Unmarried Daughter of Military Personnel: N/A 19. Educational Qualification: Matric / Equivalent PASSED 20. Percentage of marks obtained in Matric / Equivalent, if Passed: 63.60 21. Address Details:
A. Permanent Address:
AT-KOLHUWARA GACHHI TOLA
POST-TEGHRA
PS-TEGHRA
District: BEGUSARAI
State: BIHAR Pin Code: 851133
B. Correspondence Address:
AT-KOLHUWARA GACHHI TOLA
POST-TEGHRA
PS-TEGHRA
District: BEGUSARAI
State: BIHAR Pin Code: 851133
22. Educational Qualification:
Level School/College Name Board / University Name Passing Status Passing Year Percentage Secondary/Standard X S V R HIGH SCHOOL TEGHRA BSEB PATNA PASSED 2014 63.60 23.
(क) Declaration of Candidate :
(अ यथ र घ षण )
"म र र ऊपर अ कत क गय सभ व टय सह ह तथ इनक स यत क पर ज मव र म र ह व टय क अस य / अपण प य ज न पर वत आवदन / न म कन र ह न क स थ-स थ क़ नन द ड क म भ ग ह ऊ ग / ह ऊ ग स थ न म न म कन ह न क थ त म, म स थ न क नयम एव अन दश क पणत प लन क ग / क ग "
उपय त घ षण क वह त ल प म न च लख :
Place Date
आवदक क पर ह त र हद म
Candidate's Full Signature (in English)
(Not in capital letters)
(ख)
Declaration of Father / Mother / Husband / Spouse / Guardian:
( पत / म त / प त / प न / अ भभ वक र घ षण )
म न म) घ षत करत / करत ह क / मत DEEPAK KUMAR क न म कन क ब द इनक प ठ म क अव ध म उ चत च र एव इनक ऊपर कस तरह क बक य र श क लए ज म द र ह म प न म णत करत / करत ह क इनक र इस आवदन म
दए गय उपर त सभ ववरण सह ह
Place Date
पत / म त / प त / प न / अ भभ वक
क पर ह त र हद म
Full Signature of
Father/Mother/Husband/Spouse/Guardian
in English (Not in capital letters)
24. List of Enclosure:
1. 2. 3. 4. 5. 6. 7. 8. ITICAT-2017
Registration No: 3059596 Security Code: BED586 Page: 2 of 3 (PART B) 25.
(AT THE TIME OF FIRST COUNSELLING / INTERVIEW ONLY)
(i) Full Signature of the Candidate (English)
(Hindi)
(ii) L.T.I of the Candidate
(AT THE TIME OF SECOND COUNSELLING / INTERVIEW ONLY)
(i) Full Signature of the Candidate (English)
(Hindi)
(ii) L.T.I of the Candidate
(AT THE TIME OF THIRD COUNSELLING / INTERVIEW ONLY)
(i) Full Signature of the Candidate (English)
(Hindi)
(ii) L.T.I of the Candidate
26.
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF FIRST COUNSELLING) Roll No. Reservation Category Merit Serial of ITICAT-2017 in the First Year of Course of the Institute as He/She fulfilled all the requirements of being admitted. SEAL OF THE INSTITUTE
SIGNATURE OF THE
PRINCIPAL/SUPERINTENDENT
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF SECOND COUNSELLING) Roll No. Reservation Category Merit Serial of ITICAT-2017 in the First Year of Course of the Institute as He/She fulfilled all the requirements of being admitted. SEAL OF THE INSTITUTE
SIGNATURE OF THE
PRINCIPAL/SUPERINTENDENT
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF THIRD COUNSELLING) Roll No. Reservation Category Merit Serial of ITICAT-2017 in the First Year of Course of the Institute as He/She fulfilled all the requirements of being admitted. SEAL OF THE INSTITUTE
SIGNATURE OF THE
PRINCIPAL/SUPERINTENDENT
Registration No: 3059596 Security Code: 42A967 Page: 3 of 3 (PART B) ITICAT-2017
Contact this candidate