for Skill India program

1. Enrolment No………………….
To,
Managing Director,
PMKVY TC
D.S.S Institute Seohara Bijnor
UP-246746
Respected Sir,
I want to take Admission in D.S.S Institute. I Have read the ‘Term & Conditions’ of the
Institute mentioned in the prospectus and given overleaf.
I agree to abide by the same . My particulars are given below:
(It Compulsory to fill in CAPITAL LETTERS only)
First Name……………………………………………………………….Last Name…………………………………
Father’s Name………………………………………………………….Occupation…………………………….
Mother’s Name………………………………………………..………Occupation…………………………...
Date of Birth(DD/MM/YYYY………………………………………...Class……………………..............
Gender(Male/Female)…………………………………………………Caste………………………………….
Address:………………………………………………………………………………………………………………………
………………………………………………………………………...............................................................
City……………………….District ……………..State …….................PinCode…………………………….
School/College Name & Address:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
I have all Above information correct of the best of my knowledge .
……………………………. ……………………………
(Parent’s Signature) (Student Signature)