Appln. No.: ________ COURSE REGISTERATION FORM Profile of Trainee Course No: _______ Full Name (in capital letters) : ___________________________________ Age and date of birth :___________________________________ Father's Name :___________________________________ Address :___________________________________ ___________________________________ ___________________________________ State of domicile : ___________________________________ Course Applied : ___________________________________ Nature of Course (.) : New/ Revalidation Educational qualification :____________________________________ Purpose of doing the course (.) : Employment Self-employment Hobby Others (Pl. specify) Date: Signature Of Trainee For Office Use.... Submitted _____ nos. of photographs/ Proof of address and qualification Fees of Rs. __________ paid, bearing D.D No. _____________dated ________ drawn on Bank ___________________________________________________ Old license returned: _______________________________________________ Name & Designation of NIWS Official :____________________________ Signature (with date) :___________________________________
