Registration

Training Course:

Course Duration: Days

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Name Of The Participant

In Bengali

In English (Block Letter)

Short Name (for Official Use)

Father’s Name

Mother’s Name

Spouse’s Name

Present Designation

Present Station

Mobile

Telephone

Fax

E-mail (Official)

Present Residential Address

Mobile

Telephone

Permanent Address

Village / Road

House No.

Post Office

Police Station

District

Telephone (If Any)

E-mail (For Login Purpose)

Service Joining Date

Date Of Birth

Serial No. In The Gradation List

Blood Group

Emergency Contact Person

Name

Address

Telephone

Mobile

Relation With The Participant

Educational Qualification

Name of Examination	University / Board	Passing Year	Result
			Marks (%) CGPA SCALE

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Previous Training Course / Courses In JATI (If Attended)

Name Of The Course	Duration	Grade Obtained
	From To

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I Declare That, The Above Given Information Is True.

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