Online Application Form for Training

Name(as it appears on your Aadhar)*

Aadhar No*

Give Consent

Father/Mother/Spouse Name*

Date of Birth*

Year:

Month:

Day:

Gender* MaleFemale Other

Category*

Mobile*

State*

District *

Block*

Pin Code*

Relationship*

Address (Special Character ',/- are Not Allowed)*

Survey/Khasra No./ Drag No.

Email*

NTI State 1 *

NTI (1st priority)*

NTI State 2 *

NTI (2nd priority)*

NTI State 3 *

NTI (3rd priority)*

Degree/Diploma Name*

Specialisation*

Institute*

Affiliated to University/Board*

Year of Passing *

Total Marks*

Marks Obtained*

AGRICLINICS AND AGRIBUSINESS CENTERS

Department of Agriculture, Cooperation & Farmers Welfare, Government of India

Better Farming by Every Farmer

Personal Details

Applicant Id	:		Name	:			:
Date of Birth	:		Gender	:		Category	:

Residential Details

Address	:	State	:	District	:	Block	:
Pin Code	:	Mobile	:	Email	:
Aadhar No.	:

Educational Qualifications

Qualification	:	Specialisation	:	Board	:
University	:	Passing Year	:	Total Marks	:
Obtained Marks	:

Bank Account Details

Bank Name	:		IFSC Code	:		Account No.	:
Branch Address	:

Family Background

Family Field	:		Agri-Business Interest	:		Nature	:
Experience	:	Label	Establishment	:		Apptitude	:

Fee Details

Bank Name	:		DD No.	:		DD Date	:
Amount	:

Required Document

1. High School Certificate.	4. Pan Card.	7. Domicile Certificate.
2.Aadhar Card.	5.Demand Draft.
3.DOB Certifiacete.	6.Cast Certificate.

Date------------
Place------------						Signature---------------
Please send Applicantion With Document to Mention NTI.

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