CENTRAL HINDI TRAINING INSTITUTE

(Correspondence/Regular Course)
APPLICATION FORM

PROFORMA FOR ADMISSION TO PRABODH, PRAVEEN AND PRAGYA COURSES

1 Name of the Course PRAGYA
Name of the Applicant
2 S. MANIKANDAN
(In Block Letters)
3 CPF No. 43850
4 Father’s/Husband’s Name P. SUBRAMANIAN
5 Designation of the Applicant SUPERVISOR FC&D, GRADE - I
Complete Postal Address of Office MATERIALS MANAGEMENT COMPLEX,
6 including Dist./State & Pin Code (Not in DR. RAJENDRA PRASAD ROAD, BLOCK-27, NEYVELI T.S.
CUDDALORE DISTRICT, TAMILNADU,
abbreviations) PINCODE 607807.
7 E-Mail ID of candidate manidakshu@gmail.com
8 Nationality INDIAN
9 Date of Birth 05-06-1979
10 Mother Tongue TAMIL
11 Academic Qualifications MBA
Standard/Class upto which Hindi has
12 -NIL-
been studied
Name and Designation of the T. DEVARAJ, DEPUTY GENERAL MANAGER/TS
MATERIALS MANAGEMENT COMPLEX,
13 Controlling Officer with full Office DR. RAJENDRA PRASAD ROAD, BLOCK-27,
NEYVELI TOWNSHIP, CUDDALORE DISTRICT,
address (In Block Letters) TAMILNADU, PINCODE 607807

14 Telephone No. 04142-268268

15 E-Mail ID devaraj.t@nlcindia.com
16 Fax 04142-269197
17 Mobile No. 9600626188

(Signature of the Applicant)

CERTIFICATE OF THE CONTROLLING AUTHORITY

(Please ensure fulfillment of eligibility conditions before signing the certificate)

Certified that Sh./Smt./Kum. …………………………………………………………………………….. working as

………………………………………… in …………………………………………………. has been found eligible for training
and is permitted to be enrolled for ………………… Course through Correspondence to be conducted
by the Central Hindi Training Institute in the Year ………………………………

Signature
Name and Designation of the
Competent/Controlling Officer
With the Office Seal

Fax No.…………….…………… Telephone No………………………… and Mobile No.……………………………..

Place : ……………………………….
Date : ……… /……../ …………………