. Admission Acknowledgment Receipt
ALL INDIA INSTITUTE OF LOCAL SELF-GOVERNMENT<www.aiilsg.org
Online Registration Form For Admission

SANITARY INSPECTORS DIPLOMA COURSE - June 2016 to May 2017
Course Information
Registration No: 21448 Date and Time: 02/07/2016 02:47 PM
Name : OHOL GAURAV RAJESH
(Exactly indicate in the 10th std PASS/12th std PASS MARKSHEET)
Center Name: AIILSG NAVI MUMBAI
Course : SANITARY INSPECTORS DIPLOMA COURSE
June 2016 to May 2017
Medium : Marathi
Holiday Batch :

Personal Information
Gender : Male Date of Birth : 03/10/1993
Category : SC Student Address : ROOM NO-302 , KINARA BILDING , PLOT NO-48 , SECTOR -44, SEAWOOD (W) ,
City/ Village : NAVI MUMBAI District : THANE
State : MAHARASHTRA Pin Code : 400706
Phone No. : - Mobile No./WhatsApp Number : 9969740027
E-mail : gauravohol@gmal.com Religion : HINDU - MAHAR
Marital Status: Single Guardian Occupation: service
Guardian Name: Rajesh Guardian Contact Number: 9699330003
Aadhar Number: 0

In-Service/Sponsored Candidates :
Name Of Employer Address Of Employer Since Designation Job description

Education Information :
Degree Name Board/University Total Marks Marks Obtained Passing Year Stream Attempts
HSC MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION , PUNE 650 286 2015 science 1
S.S.C MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDRY EDUCATION , PUNE 650 415 2009   1

Documents to be Submitted :
1S.S.C Marksheet
2H.S.C Marksheet
3School leaving Certificate
4Cast Certificate



I read the important instructions governing the admission rules to the course as mentioned in AIILSG Online Admission portal and I agree to the same.

_________________________
(Student Signature)
OHOL GAURAV RAJESH



For Office use only:
This is to certify that OHOL GAURAV RAJESH registration is Accepted/ Not Accepted.



___________________________________
( Signature )

Name:
(AIILSG Center Head / Principal / Course Coordinator )

Date: