डा0 भीमरॉव अम्बेडकर प्रशिक्षण संस्थान (डॉ0. भी. अ. प्र. सं. )
DR. BHIMRAO AMBEDKAR TRAINING INSTITUTE (DBATI)
(डा0 भीमरॉव अम्बेडकर प्रशिक्षण संस्थान सोसाइटी उत्तर प्रदेश सरकार द्वारा मान्यता प्राप्त और
अंतरराष्ट्रीय मानकीकरण संगठन द्वारा मान्यता प्राप्त )
(Authorized By:-Dr. Bhimrao Ambedkar Training Institute Society,
An ISO Certified Government Of India)

Application Form: 2018-2019

Regd. No
Branch No
Slip No


Course  

1.Name Of The Candidate (as in high school certificate)


2.Mother's Name Of The Candidate (as in high school certificate)


3.Father's Name Of The Candidate (as in high school certificate)




4.Date Of Birth(as in highschool certificate) 
Day
Month
Year

5.Gender 
Male
Female

6.Category 
Gen.
Sc.
Obc.
St.

7.Nationality 
Indian
Other.
Please Specify


8.Permanent Address Of Candidate


Pin 

9.Contact Number Of Applicant
Mobile 

10.Contact Number Of Parents
Mobile 


11.Date Of Admission 
Day Month Year



Undertaking By Applicant

I Solemnly affirm that the information given in the application form is correct and i very well understand that my admission will be cancelled,If any information is found false/incorrect.

I am not suffering from any contagious disease , which is likely to spread to other students or may disturb the teaching I also solemnly affirm that I am not a member of any banned organization.There is no punishable case pending in any court against me nor have been punished by any court.There is no report of any serious offence register in police against me.

Signature Of Applicant Signature Of Parents Signature and seal of the management