Admission Centre Form

To

SRJ Institute of Skill Development


We are submitting our consent to provide you the required infrastructure for the Centre to be conducted by you with following details.

(A) Institution Details

(B) Personal Information

S.No.	Designation	Name	Email ID	Mobile Number
1.*
2.
3.
4.
5.

(C) Infrastructure Details (Select One from each)

S.No.	Room Type	Furniture	Air Conditioned	Seating Capacity
1.	Select Hall Room	Select Table Chair Bench Other	Select Yes No
2.	Select Hall Room	Select Table Chair Bench Other	Select Yes No
3.	Select Hall Room	Select Table Chair Bench Other	Select Yes No

(D) Documentation

Head Photo :		Aadhaar Card :
Qualification :		Centre Outside Photo :
Centre Outside Photo :
Type of Exam (Theory / Practical) :		Theory & Practical
		Time : 9:00 AM to 7:00 PM

I hereby certify that the information provided above is true to the best of my knowledge and belief. If any information is found to be false/ incorrect, it will reject my centre in SRJ Institute of Skill Development , HISAR.

Yours Truly

Name :
Designation :
Date :