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FORM OF TRAINING PROVIDER (TP)

DETAILS OF TRAINING PROVIDER (TP)

Name of Training Provider:

Address of Registered/Corporate Office:

District:

Subdivision:

Municipality:

Block:

Gram Panchayat:

City:

Police Station:

Post Office:

Pincode:

State:

Telephone no:

Mobile no:

Email id:

Fax no:

CENTER DETAILS

Centre Name:

Centre Address:

Block:

Gram Panchayat:

Whether Empanalled With PBSSD or Not.(Please Specify):

Name of the In-Charge of the Center:

Registration Number as per SDI portal: (If Any):

Date of Application in the SDI portal: (If Any):

Ownership Status of the premises (Please Tick): (If Any):

If rented, duration of rent/lease:

Broadband connectivity/ data Card Bill ( in the name of Training Provider) :

Proof related to Power Connection ( Copy of Latest Electricity Bill to be enclosed):

GPRS enabled Bio Metric Thumb Impression Machine with battery back up installed:

FACILITIES AVAILABLE FOR EACH COURSE:

For Course/Module 1:

Training to be conducted in Room Nos.

Whether the Theory room size is as per the required size:

Whether the Workshop room size is as per the required size :

For Course/Module 2:

Training to be conducted in Room Nos.

Whether the Theory room size is as per the required size:

Whether the Workshop room size is as per the required size :

For Course/Module 3:

Training to be conducted in Room Nos.

Whether the Theory room size is as per the required size:

Whether the Workshop room size is as per the required size :

For Course/Module 4:

Training to be conducted in Room Nos.

Whether the Theory room size is as per the required size:

Whether the Workshop room size is as per the required size :

For Course/Module 5:

Training to be conducted in Room Nos.

Whether the Theory room size is as per the required size:

Whether the Workshop room size is as per the required size :

For Course/Module 6:

Training to be conducted in Room Nos.

Whether the Theory room size is as per the required size:

Whether the Workshop room size is as per the required size :

(TRAINERS QUALIFICATION CRITERIA AS PER SDI GUIDELINE IS TO BE CHECKED)

Equipment/Machinery and Tool Kit are available as per revised course requirement:

Status:

Schedule Of Training :

Number of Days Per Week

Start Time and End Time

Total Hour of Training

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