BHARAT SANCHAR NIGAM LIMITED

REGIONAL TELECOM TRAINING CENTRE

THIRUVANANTHAPURAM 695 040

APPLICATION FOR THE TRAINING PROGRAMME ON BSNL CERTIFIED OPTICAL FIBER TECHNICIAN

Important Notes: (i) Before filling this form, read the brochure carefully. (ii) All entries should be made legibly.

1Name

2Fathers Name

3Age and Date of Birth

4Gender (Please put mark)MaleFemale

5Nationality

6Address for Communication

7Permanent address

8Educational QualificationBranch/

SpecialisationPercentage of

Marks obtained

9Brief description about work experience (If applicable)

10Mobile No11Email id

12Batch Applied forBCOFT 01/2015-1622.06.2015

13Whether hostel facility required?

(Please put mark)YesNo

14Registration fee: (DD for Rs. 200/, in favour of A.O. (Cash), O/o CGM BSNL, Thiruvananthapuram)

DD No.DateName of BankBranch AddressAmount (Rs.)

(Applicant should write Name, Course applied for, on the reverse side of the Demand Draft)

DECLARATION

I do hereby declare that all the statements made in the application are true, complete and correct to the best of my knowledge and belief.

Place:

Date:

(Signature of the Applicant)

Please affix one recent passport size Photograph without attestation

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