Online Registration for Admission 2020-21

Full Name (As per 10th class marksheet )^*

Father Name (As per 10th class marksheet )^*

Mother Name (As per 10th class marksheet )^*

Date of Birth ^*

Age as on 01.08.2020

Mobile No. ^*

Email ^*

Gender ^*—Please choose an option—MaleFemale

Religion ^*—Please choose an option—HinduMuslimChristianSikhBuddhistParsiJainOthers

Category (A)^*
—Please choose an option—GeneralSCSTOBCOther

Category (B) ^*
—Please choose an option—PH (Physically Handicapped)Widow/DivorceeEx. ServicemanNa

Is Applicant having Smart Phone ?
YesNo

Have you been Admitted in any ITI course before?^*YesNo

State^*

City^*

Pin Code

Current Address^*

Permanent Address^*

Trade^*—Please choose an option—ElectricianFitterMech. (RAC)Mech. (Diesel)

Student Photo (Max Size 200KB)^*

Student Signature (Max Size 200KB) ^*

2

12th

Science/MathScience BiologyCommerceArtsOther

3

Other

B.A.B.Com.B.ScM.A.M.Com.M.Sc.PolytechnicB.Tech.Other

Upload Documents (All Documents Max Size 200KB)

*Bank Account Details
(For Online Payment of Fee through UPI/RTGS/NEFT/Internet Banking)*

Name of Bank- Punjab National Bank
Name of Account- Bhushan Pvt Industrial Training Institute
Account No.- 4144002100014654
IFSC Code- PUNB0414400