Trainer Application Details

01 Name of the Applicant MOUSUMI SAHA
02 Photo
03 Father’s / Mother’s Name Gokul Saha
04 Permanent Address 1738664950_IMG-20250203-WA0023.pdf Download
Address Line 1: House no 20, preetilata lane
Address Line 2: Sukanta nagar
District Jalpaiguri
Block Rajganj
Municipality/ Panchayat Siliguri municipal corporation
Village/ Town Siliguri
PIN Code 734006
05 Correspondence Address Address Line 1 House no 20, preetilata lane
Address Line 2 Sukanta nagar
District Jalpaiguri
Block Rajganj
Municipality/ Panchayat Siliguri municipal corporation
Village/ Town Siliguri
PIN Code 734006
06 Mobile No 7679629178
07 Alternate Mobile No 7679138357
08 Email ID shiladityakarmakar42@gmail.com
09
Date of Birth
1989-03-01		 Gender
Female		 Age
35
10 PAN No. DTEPS5060J Download
11 Aadhaar No 509306198295 Download
12 UDYAM Registration No Download
13 Artisan Card No. Download
14 Brief Portfolio of the Candidate
15 Highest Educational Qualification. Diploma in telecommunications engineering Download
16 Occupation. Jewellery designer
17 Highest Professional Qualifications in the Trades Applied for Fashion Jewellary and Costume Jewellery Diploma in jewellery making Download
18 Recognition/ Empanelment/ Affiliation
19 Work Order / Completion Certificate of Training Programmes conducted under Govt. Organisations/ reputed Non-Govt. Organisations in last 3 years
20 Awards / Accolades (If any)
21 Photos of Training Programmes/ Awards Received
22 Transaction Details
Upload Transaction Details
1738664950_IMG_1425.pdf Download		 Transaction No
540073188305		 Date of Transaction
2025-02-03		 Amount of Transaction
500		 From Bank
Bandhan bank
23 Any other Related Information
24 DISTRICTS AND TRADES APPLYING FOR EMPANELMENT Darjeeling(Fashion Jewellary and Costume Jewellery,Hand Fabric)
Jalpaiguri(Fashion Jewellary and Costume Jewellery,Hand Fabric)
25
Date
2025-02-04		 Place
Siliguri 		Signature
1738664950_rsz_img_1427.jpg Download
Declaration (Individual Trainers)
I hereby declare that –
1. The information furnished above are true to best of my knowledge.
2. I would strictly abide by the Terms & Conditions stated in the “Expression of Interest” and deliver the services as required with optimum sincerity.
3. I have not been barred/ banned/ restricted from any such services from any Govt. or Non-Govt. Organisations in the past.
4. I have a clean legal background and no Criminal Case has been filed against me in the Court of Law as per my knowledge.
5. I am able to serve as a Training Provider for both short and long duration Programmes of the selected trades in the Urban and Rural Areas of the selected District/s of West Bengal along with all types of Machineries, Equipments and Training Material support as and when required.
6. I am capable of providing Marketing and Network building Support temporarily for the Target groups of Trainees.