Online Application Form for Training

Personal Details

Name(as it appears on your Aadhar)* Enter Name

Aadhar No* Only Numbers allowed Enter Aadhar No.

Give Consent

Father/Mother/Spouse Name* Please check Father Name

Date of Birth*

Year:

Month:

Day:

Gender* MaleFemale Other

Category*

Mobile* Enter Mobile Number Enter Correct Mobile Number

State* Select State

District * Select District

Block* Select Block

Pin Code* Enter Correct Pin Number

Relationship* Select Relationship

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

Survey/Khasra No./ Drag No.

Email* Enter Email Address

Select NTI

NTI State 1 * Select NTI State 1

NTI (1st priority)* Select NTI

NTI State 2 * Select NTI State

NTI (2nd priority)* Select NTI

NTI State 3 * Select NTI State

NTI (3rd priority)* Select NTI

Educational Qualifications

Degree/Diploma Name* Select Degree/Diploma

Specialisation* Select Specialisation

Institute* Enter Board/Institute/University

Affiliated to University/Board* Enter University Affiliation

Year of Passing *

Total Marks*

Marks Obtained* Obtained marks can not be greater than total marks

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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