Nominees Info

  Name of Course/Workshop ------------------------ Period From ------- to --------
1.  Full Name In Capital Letters  ___________________________________________
2.  Designation  ___________________________________________
3.  Sponsoring Authority
a) Circle  ___________________________________________
b) Division  ___________________________________________
4.  Date of Birth  ___________________________________________
a) Age on the start of Course :  ___________________________________________
(Required to be less than 55 years for Short Term Course & 50 years for Long Term Course)
5.  Sex  ___________________________________________
6.  Address for Communication  ___________________________________________
(with Pin Code)  ___________________________________________
Telephone Number  ___________________________________________
Fax Number  ___________________________________________
Email  _____________________________________________
7.  Is the subject of this Course/ Workshop related to your present nature of work ?  ___________________________________________
8.  Has nominee attended any other similar training course ? If yes, give details.  ___________________________________________
9.  Details of Computer Courses completed if any  ___________________________________________

Nominee's Signature


Signature of sponsoring authority

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