PERSONAL DETAILS Name [Asper Class X Marksheet] Gender Select Male Female D.O.B. Marital Status Select Single Married Divorced Caste Category Select General SC ST OBC Minority Aadhaar number Aadhaar Enrolment Number Any other Govt. ID proof Select Voter ID PAN Card Driving License Passport if Yes, Mention ID No Disability Category Select No Disability Hearing Impaired intellectual Disability Orthopaedically Impaired Visual Impaired Learning Disability Neurologically Disability Acid Attack Victims Blood Disorder Do you have disability Certificate/ Disability card? No Yes If Yes, Mention the no. Present Address District: State: PIN CODE: Contact No Alternate contact No: E-mail ID: Educational Level Select 8th Pass 10th Pass 12th Pass Under-Graduate Graduate Stream Post Graduate ITI Polytechnic other Employment Details: Select Student Un-Employed Self-Employed Employed If Employed/Self-employed: No Full Time Part Time Employer Name: Designation: Current Salary [Monthly]: Years of Experience: 0 1 2 3 4 5 6 7 8 9 10 Mother/Father/Spouse/Guardian Name: Mother/Father/Spouse/Guardian Contact Number: Mother/Father/Spouse/Guardian Occupation Total Family Income [Monthly]: Referred By Associates Current/Ex-student Direct Walk -in Newspaper /ads Door to door Friends NGO Partner Pamphlets/Posters Local Govt. Department Others, Specify Photo Aadhaar Card Pan Card 10th 12th Others Certify that the informaGon provided above is true & correct to the best of my knowledge, information & belief. I shall adhere to SMART guidelines & instructions. I accept all decisions pertaining to training, placements & assessments shall be final and binding on me. O£8gree to adhere to the soRware and internet usage policy of Tech Mahindra Foundation wherein I shall not ill5tgll, download, copy and duplicate any unauthorized or unlicensed software, programs, games, attachments on the computer systems being used In the Tech ihahindra Foundation SMART Centre. Aiso, I agree to use internet for the intended purpose only. Bfàerebyallow Tech Mahindra Foundation to use my photograph, case study and other such information for social media usage. I also hereby allow Tech Mahindra Foundation to verify siatus of my employment directly or through third party agencies. thereby submit voluntarily at my own discretion, the physical copy of Aadhaar card as issued by UIDAI (Aadhaar), to the Tech Mahindra Foundation SMART Centre for the purpose of establishing my identity / address proof. The same shall be stored in the SMART MIS system of Tech Mahindra FoundaGon. The consent and purpose of collecting Aadhaar has been explained to me in local language. Tech Mahindra Foundation SMART Centre has informed me that my Aadhaar submitted to the centre herewith shall not be used for any purpose other than mentioned above, or as per requirements of law. Submit
