Title (required)

First Name (required)
Middle Name
Last Name (required)

Date Of Birth (required)
Place Of Birth

Gender : Male Female Transgender 
Guardian Type : S/O D/O W/O C/O 

Name Of Father/Guardian (required)

First Name (required)
Middle Name
Last Name (required)

Mother’s Maiden Name:
Ration Card Number:

Aadhaar Enrollment Number:
Aadhaar (UID) Number:

Cast Category : Gen OBC SC ST NA 

Physical Disability:
Yes No 
If Yes :
Hearing Impaired Visually Impaired Other 

Religion:
Hindu Muslim Christian Sikh Buddhist Jews Other 

Mother Tongue
Marital Status :
Single Married 

Current Address:
Taluka:

District:
State:
PIN Code:

Permanent Address:
Taluka:

District:
State:
PIN Code:

Contact Number:

Type Of Mobile :
Smartphone Other 
Mobile Owner :
Self Other 
If Other, Please Specify name of Mobile Owner:

Pre Training Status : Fresher Experienced 

Previous Experienced:
Year

Months

Educational Level : Uneducated Under Graduate Graduate Post Graduate I T I Polytechnic Diploma 

Technical Education :
Yes No 
Please Specify Education:

Monthly Earning or CTC before Training: Rs
Below Poverty Line :
Yes No 

Annual Household Income(Rs.) :
Below 96 Thousand 96 Thousand to 2.5 lakh 2.5 lakh to 5 lakh 5 lakh & Above 

Source of information about Training :

Interested in taking admission for :
Duration:

Date Of Admission:
Batch Timing:

Batch Start Date:
Batch End Date:

Total Fees( Amt in Rs):

I hereby declare that the above information is true. I read and understood MITCON’s guidelines mentioned in “Student’s Hand Book”. I accept the same.

Location:

Date:

Signature of the candidate:

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