Government of Bihar

Bihar Combined Entrance Competitive Examination Board

Online Application Form for admission in the Professional Trades/Courses for session 2024 of the Industrial Training
Institute of Govt. of Bihar.

Registration No.
Please do not send this Hard Copy to BCECE Board
3240076307
PART A
1. District in which ITI's of your choice
SUPAUL
are situated :

2. Candidate's Name : MITHUN KUMAR

3. Father's Name : YOGENDRA PRASAD YADAV

4. Mother's Name : LAXMI DEVI

5. Date of Birth : 09 / SEPTEMBER / 2005

6. Gender : MALE

7. Category : BC (BACKWARD CLASS)

8. Disabled Quota : NO

9. Mobile No : 829****575

10. Email ID : MITHUNYADAV11927@GMAIL.COM

11. Aadhaar No : 554091603028

THE CUT MARK IN LEFT HAND OF INDEX Note : Please Affix your same photo and put your full signature in
12. Mark of Identification : English and Hindi in space provided above
FINGER

13. Are You Permanent Resident of Bihar? : YES

14. Residential Eligibility :

15. Are you unable to write due to permanent loss of limbs / suffering from Cerebral
N/A
palsy :

16. Do you claim for Economically Weaker Section (EWS) ? : N/A

17. District for which residential certificate is obtained : SUPAUL

18. District of institute of passing/appearing in Matric /Equivalent exam: SUPAUL

19. District where your father/mother is employed and for which employer's certificate is
SUPAUL
obtained:

20. Do you claim Land Donar Quota : N/A

21.(i) Do you claim SMQ Quota : NO

21.(ii) If yes, are you Son/Unmarried Daughter of Military Personnel : N/A

22. Educational Qualification: Matric / Equivalent : PASSED

23. Percentage/CGPA of marks obtained in Matric / Equivalent, if Passed : 42.60%

Registration No: 3240076307 Page: 1/6

 24. Payment Details :

Payment Mode Journal No./Transaction No. Deposit Date Amount (in Rs.)

UPI ZIC51962786081 04/05/2024 08:30 PM Rs.SEVEN HUNDRED AND FIFTY ONLY

25. Educational Details :

% of
School/ College Board/ University Passing Passing Marks Total
Level marks /
Name Name Status Year Obtained Marks
CGPA

UTKRAMIT BIHAR SCHOOL

SECONDARY/STANDARD X MADHYAMIK EXAMINATION PASSED 2021 213 500 42.60%
SCHOOL SAMDA BOARD

26. Address Details

A. Permanent Address: B. Correspondence Address:

SAHEBAN, SUPAUL, BIHAR SAHEBAN, SUPAUL, BIHAR
District: SUPAUL District: SUPAUL
State: BIHAR State: BIHAR
Pin Code: 854338 Pin Code: 854338

27. Declaration by the Candidate :

I MITHUN KUMAR declare that the informations furnished above are correct and I shall forfeit my candidature and will be liable for legal action in
case of any of them is proved to be false at any stage inclusive of admission or thereafter.

Date : .......................

Place : ...................... (Signature in English) (Signature in Hindi)

Registration No: 3240076307 Page: 2/6

 Government of Bihar
Bihar Combined Entrance Competitive Examination Board
Online Application Form for admission in the Professional Trades/Courses for session 2024 of the Industrial Training
Institute of Govt. of Bihar.

Registration No.
Please do not send this Hard Copy to BCECE Board
3240076307
PART B
Selected for admission (1st Counselling) Selected for admission (2nd Counselling) Selected for admission (Mop-Up Counselling)
Against Roll No........................................... Against Roll No........................................... Against Roll No...........................................
Category.......................................................... Category.......................................................... Category..........................................................
Merit Serial....................................................... Merit Serial....................................................... Merit Serial.......................................................
at...................................................(institution) at...................................................(institution) at...................................................(institution)
in...................................................(Trade/Course) in...................................................(Trade/Course) in...................................................(Trade/Course)

...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ......................

Signature of Signature of Controller of Signature of Signature of Controller of Signature of Signature of Controller of
the the verifying Examination the the verifying Examination the the verifying Examination
Candidate Officer BCECEB Candidate Officer BCECEB Candidate Officer BCECEB
(At the time of ITICAT-2024 (At the time of ITICAT-2024 (At the time of ITICAT-2024
Counselling) Counselling) Counselling)

Date : ....................................... Date : ....................................... Date : .......................................

1. District in which ITI's of your choice

SUPAUL
are situated :

2. Candidate's Name : MITHUN KUMAR

3. Father's Name : YOGENDRA PRASAD YADAV

4. Mother's Name : LAXMI DEVI

5. Date of Birth : 09 / SEPTEMBER / 2005

6. Gender : MALE

7. Category : BC (BACKWARD CLASS)

8. Disabled Quota : NO

9. Mobile No : 829****575

10. Email ID : MITHUNYADAV11927@GMAIL.COM

11. Aadhaar No : 554091603028

THE CUT MARK IN LEFT HAND OF INDEX Note : Please Affix your same photo and put your full signature in
12. Mark of Identification : English and Hindi in space provided above
FINGER

13. Are You Permanent Resident of Bihar? : YES

14. Residential Eligibility :

15. Are you unable to write due to permanent loss of limbs / suffering from Cerebral
N/A
palsy :

16. Do you claim for Economically Weaker Section (EWS) ? : N/A

Registration No: 3240076307 Page: 3/6

17. District for which residential certificate is obtained : SUPAUL

18. District of institute of passing/appearing in Matric /Equivalent exam: SUPAUL

19. District where your father/mother is employed and for which employer's certificate is
SUPAUL
obtained:

20. Do you claim Land Donar Quota : N/A

21.(i) Do you claim SMQ Quota : NO

21.(ii) If yes, are you Son/Unmarried Daughter of Military Personnel : N/A

22. Educational Qualification: Matric / Equivalent : PASSED

23. Percentage/CGPA of marks obtained in Matric / Equivalent, if Passed : 42.60%

24. Address Details

A. Permanent Address: B. Correspondence Address:

SAHEBAN, SUPAUL, BIHAR SAHEBAN, SUPAUL, BIHAR
District: SUPAUL District: SUPAUL
State: BIHAR State: BIHAR
Pin Code: 854338 Pin Code: 854338

25. Educational Details :

% of
School/ College Board/ University Passing Passing Marks Total
Level marks /
Name Name Status Year Obtained Marks
CGPA

UTKRAMIT BIHAR SCHOOL

SECONDARY/STANDARD X MADHYAMIK EXAMINATION PASSED 2021 213 500 42.60%
SCHOOL SAMDA BOARD

Registration No: 3240076307 Page: 4/6

 26.(A) Declaration of Candidate :

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

Place : ..............................

.......................................................................... ..........................................................................
Date : ..............................
(Candidate's Full Signature (in English)
(Not in Capital letters))

(B) Declaration of Father/Mother/Husband/Spouse/Guardian :

MITHUN KUMAR

Place : ..............................

.......................................................................... ..........................................................................
Date : ..............................
Full Signature of
Father/Mother/Husband/Spouse/Guardian in
English (Not in Capital letters)

27. List of enclosures :

1. .................................................................................... 2. ....................................................................................

3. .................................................................................... 4. ....................................................................................

5. .................................................................................... 6. ....................................................................................

7. .................................................................................... 8. ....................................................................................

Registration No: 3240076307 Page: 5/6

28.
(AT THE TIME OF FIRST COUNSELLING/INTERVIEW ONLY)

(II.) L.T.I. of the Candidate

(English) ........................
(I.) Full Signature of Candidate
(Hindi) ...........................

(AT THE TIME OF SECOND COUNSELLING/INTERVIEW ONLY)

(II.) L.T.I. of the Candidate

(English) ........................
(I.) Full Signature of Candidate
(Hindi) ...........................

(AT THE TIME OF MOP-UP COUNSELLING/INTERVIEW ONLY)

(II.) L.T.I. of the Candidate

(English) ........................
(I.) Full Signature of Candidate
(Hindi) ...........................

29.
FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF FIRST COUNSELLING

Roll No. .............................................. Category .............................................. Merit Serial .............................................. of ITICAT-2024 in the First

Year of .............................................. Course of the Institute .............................................. as He/She fulfilled all the requirements of being admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE PRINCIPAL / SUPERINTENDENT

FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF SECOND COUNSELLING

Roll No. .............................................. Category .............................................. Merit Serial .............................................. of ITICAT-2024 in the First

Year of .............................................. Course of the Institute .............................................. as He/She fulfilled all the requirements of being admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE PRINCIPAL / SUPERINTENDENT

FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF MOP-UP COUNSELLING

Roll No. .............................................. Category .............................................. Merit Serial .............................................. of ITICAT-2024 in the First

Year of .............................................. Course of the Institute .............................................. as He/She fulfilled all the requirements of being admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE PRINCIPAL / SUPERINTENDENT

Registration No: 3240076307 Page: 6/6