(ITP Web Registration Acknowledgment Form - Print in Portrait format on A4 size paper)

  Date:   24/03/2019
 
TIN NO: ACK NO.   125806035R
 
Name of  
  :Mr Mukul Goyal
Applicant

State for
GST   :UTTARANCHAL
calculation Please affix your latest
Photograph
Date of
  :26-Oct-1997
Birth

  :Payment by Online (र 472.0) (Successful online payment received against

Mode of
Payment bank transaction reference number (Trace number): pay_CAKlc3JbyHU9DF  
for your NSR web-registration)

Employer
  :--  
Name

Employee
  :-- Signature
Number
(Please sign in the centre of the box)

Valid Up
  :13/05/2019  
To Date

Note :
* To complete your registration please visit any Point of Service (POS) office. If you do not complete your registration within
50 days of issuance of Acknowledgement Number, your data will be purged from the system.
* You need to take print-out of this form to the POS along-with ORIGINAL proof of Photo Identity [Voter's Id
card/Passport/Driving License/Bank Pass Book (with Photo)/College ID card (not more than 4 years old)/PAN
card/Employment Identity Card].
* NSR registration fee is subject to change as per GST requirement.
* I have read, understood and I agree to the terms and conditions available on NSR website
https:\\nationalskillsregistry.com relating to my joining and using NSR and I agree to the same.

ACKNOWLEDGEMENT SLIP(For the use of POS only)

TIN NO :   Ack No :  125806035R
Name of Applicant  : Mr Mukul Goyal POS ID :  

          1.   Received the Application form for Registration as ITP in the National Skills Registry and payment made by ITP for
Registration is Payment through Online.

Date:___________
(POS Seal and Signature)
Print