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High Voltage Course

This document is an admission form for a course at SEI Educational Trust in Kolkata. It collects information such as the applicant's name, date of birth, address, nationality, rank/designation, employer, blood group, allergies, emergency contact, and course applying for. The applicant declares that the information provided is true and correct. The form is then signed by the applicant. For office use, there are sections to verify eligibility criteria are met, check if additional documents are submitted for certain courses, and record payment receipt number.

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Sundram kumar
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36 views

High Voltage Course

This document is an admission form for a course at SEI Educational Trust in Kolkata. It collects information such as the applicant's name, date of birth, address, nationality, rank/designation, employer, blood group, allergies, emergency contact, and course applying for. The applicant declares that the information provided is true and correct. The form is then signed by the applicant. For office use, there are sections to verify eligibility criteria are met, check if additional documents are submitted for certain courses, and record payment receipt number.

Uploaded by

Sundram kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM ID :- KOL/FORM/2022/087524

SEI EDUCATIONAL TRUST, KOLKATA

SEIET Date effective: 01 Apr 2018 Prepared by:(QSC)

QUALITY SYSTEM FORMS Rev. 00 Checked by:(QCC)

QSF-ADM-01-A Page 1 of 1 Approved by:(HOI)


Admission Form DGS Approved Course

ADMISSION FORM

Courses Applied for :

1. Full Name* : KUMAR SHIVAM


(Block Letters) (Surname) (OtherNames)


2. Rank / TME 3. InDoS No* : 15EL2547

Designation :

4. Date of Birth : 12/December/96 5. Nationality : Indian Employer :


6. Permanent Address: Village Langarpur
Barh Patna 7. Present Address : Langarpur
Barh
Patna
Email ID* : [email protected] Phone Number : 9430213978

We want you safe - however for any Blood Group : A+ Whether allergic to any If yes,whether any
  Yes   Yes
unexpected Emergency situation medication (Y/N) : details submitted :
please provide the following   No
  No
information

Next of kin name : Anita Devi Relation to self : Mother Telephone Contact 9771537473
Nos.in Emergency :

Additionally for canditates of Refresher Courses.


8. Number of the NA Issued by (name of the NA INDoS no : NA
Cert.which is being Institute) : (Institute)

refreshed :
Declaration to be made by the applicant: I hereby declare that the particulars furnished above are correct and true to the best of my knowledge and belief. I further indemnify
the institute against the consequences resulting from my submission of false or untrue statements/documents.

Signature of the Applicant

For Office use only

Eligibility Verification (to be done by Course in Charge) Indemnity Accounts


Eligibility Criteria Additionally for candidates of Fee Receipt
·  6 MONTHS SEA SERVICE PST/PSCRB/FPFF/AFF Courses no.
1. Indemnity Form
Verified (Signature)
Submitted (Y/N)
2. Medical Fitness
Sign (Accounts officer)
Certificate (Y/N)
Name of CIC/Person verifying the CANDIDATE'S REGISTRATION NO.
documents

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