PARTICULARS OF
ITEC/SCAAP NOMINEE
(For use of Ministry of External Affairs)
(TC Division only)
This portion will
be detached from the main ITEC/SCAAP form and kept in the TC Division for record.
(To be filled in by the Officer responsible for the ITEC/SCAAP work
in the High Commission/Embassy of India)
1.
Name & Designation
:
2.
Name of Employer & :
Parent Department
3.
Permanent Address
:
4.
Name of Course and
Training
Institute in India :
5.
Duration :
Note :
Indian Mission must
satisfy itself before forwarding the
nomination form that :
(i)
the nominee has not availed of training facilities
under ITEC/SCAAP earlier;
(ii)
Two copies of the form, duly completed in all respects are forwarded;
(iii)
The forms reach the TC Division, Ministry of External
Affairs at least two months before commencement of the course.
STATION
NAME
DESIGNATION
(TO BE SIGNED BY HOM OR CDA)
(To be
filled in by Officer responsible for the ITEC/SCAAP work in TC Division)
A. Sanction
No./Date
:
B. Remarks/Observations :
(TC Division)
PHOTO
|
Name of the
Course
:_________________________________________
Commencing
from
:____________________To___________________
Name of the
Institute
:_________________________________________
(To be completed by the nominee)
1. Personal
Particulars of the nominee
a.
Name
:_______________________________________________
b.
Surname, if any
:_______________________________________________
c.
Male/female
:_______________________________________________
d.
Marital status
:_______________________________________________
e.
Date of birth
:_______________________________________________
f.
Nationality
:_______________________________________________
g.
Address/Tel. No.
:_______________________________________________
________________________________________________________________________
h.
Name and address of person to be notified in case of
emergency :
Tel. No.
i.
Food habits(vegetarian/non-vegetarian)
:_______________________________
2.
Educational Qualification :
Particulars of
Deg/Dip /Certificates
|
Year of
passing |
Name of
Educational Institute |
Location |
|
|
|
|
3.
Give Details of any other professional qualification
which you possess :
Particulars of Profe- ssional
Qualification |
Year of
passing |
Name of
Educational Institute |
Location |
|
|
|
|
4.
Employment Records :
Particulars of Posi- tion held |
Year |
Nature of Work |
|
|
|
5.
Are you an employee of
government/quasi-government/private company or
are you self-employed ? ___________________________________________
6.
Name and address of your present employer :
Name
|
Address |
|
|
7.
Details of courses attended, if any, outside your
country to upgrade your technical/professional
skills :
Name of the
country |
Name of
courses and its duration |
Year |
|
|
|
8.
State briefly in 100 to 150 words, the reasons, both
personal and professional, for your interest in receiving the training.
DECLARATION
I ________________________________________________________________
(USE BLOCK LETTERS SURNAME LAST)
of(country)__________________________________________________certify that
statement made by me in PART - I of this form is true, complete and correct
to the best of my belief ;
if accepted for training award, I undertake to :
(a) carry out such instructions and abide by such conditions as may be
stipulated by both the nominating and donor Government, in respect of training;
(b) to follow the course of study or training and abide by the rules of
the university or other institutions or establishment in which I undertake to study or
gain training;
(c)
submit progress report which may be prescribed;
(d) to refrain from engaging in political activities, or from any form
of employment for profit or gain;
(e) return to my home country at the end of my course of study or
training.
I
also fully understand that if I am granted a training award it may be subsequently
withdrawn if I fail to make adequate progress or for other sufficient cause determined by
the host Government.
Date
:
Place
:
(SIGNATURE OF THE NOMINEE)
PART
- II
Certify that :
(a)
I have examined the educational, professional and other certificates quoted by the
nominee in Part – I of this form
and I
am satisfied that they are authentic and relate to the nominee.
(B)
I have examined the medical certificates and X-ray
reports produced by the nominee which state
that he is medically fit and free from any infectious disease such as AIDS and yellow
fever and that having regard to his physical and mental history there is no reason to
suppose that the nominee is other than fit to undertake the journey to India and to remain
under training in that country.
(c) The nominee has sufficent knowledge of
spoken and written English
to enable him to follow the course of training for which he is being nominated.
(d) The nominee has
not availed of ITEC/SCAAP training facilities earlier in India.
I nominate Mr./Mrs./Miss
_________________________________________________
on behalf of the Government of
____________________________________________
Dated:
Signature_____________________________
Place:
Designation
___________________________
(with seal)