Uttar Pradesh Skill Development Mission

DEPARTMENT OF VOCATIONAL EDUCATION AND SKILL DEVELOPMENT

Application Form for Flexi- Training Partner

Section 1: Applicant Details
Name of Applicant Entity
Type of Entity
PAN No.
TIN No.
Date of Registration of
Applicant as legal entity
Registration No.
Registered Address
Pin Code

Date:

Section 2: Financial Details of Applicant (Last Three audited financial years)

Sr. No.
Financial Year

Turnover
Annual Turnover (Rs)

Annual Net worth (Rs.)

(i)
(ii)
(iii)

Section 3: Training experience of applicant in skill development: Yes/No

If yes then Please highlight assignments with Government/UN/ World Bank/other donor funded
/ self funded /skill development/livelihoods/ projects completed/ongoing in last 5 years prior to
the date of application to be given.
Total
Total
Sr.
Year of
Total
candidates
Project Name
Trained
No
Completion Target
absorbed in
Candidates
company
1
2
3
4
5

Section 4: Details of Core Business Activities (Max: 100 Words)

Section 5: Employees as per wages

Sr. No.
1
2
3

Level
Minimum wages - 10,000
10,000 - 20,000
20,000- above

No. of Employees

Section 6: Choice of Courses (MES/QP-NOS courses only)

**(Course List Attached)
Sr. No.

Sector

MES/
QPNOS
Code

Course Title

Category
of the
Course
(A,B,C)

Course
duration in
hours

List below any courses which are other than MES or QP-NOS

Section 7: District-wise year-wise Training & Placement Targets

Minimum placement to be achieved by Flexi-MoU training partner is 80%; this can be achieved by
captive placement or by placement in other companies in relevant sector.

Financial
Year

Proposed
District
for
Training

Proposed
Place/Centre of
Training
(Government/
Private)

Proposed
Investment
in the
Centre of
Training

Proposed
Training
Target

Placement
Target
(within the
Applicant
Entity)

Placement
Target
(in other
companies)

Section 8: Choice of Scheme for Training (If Any)

Sr. No.
1
2
3
4
5
6
7
8
9

Scheme for Training

Yes/No

Skill Development Initiative (SDI)

Multi Sectoral Development Program (MSDP)
National Rural Livelihood Mission (NRLM)
State Skill Development Fund (SSDF)
Employment through Skill development and placement under National
Urban Livelihood Mission (EST & P under NULM)
Border Area Development Programme (BADP)
Building and other Construction Workers (BOCW)
Mixed Batch (Which permits all types of Schemes)
No particular choice

Section 9: Scanned documents attached in support of application

Annexure
Point for which document is attached
No.
1
Registration Certificate as legal entity
2
CA certificate for balance sheet/turnover
Project Completion Certificate, if Yes in
3
section 3
Letter supporting Placement of
4
Candidate(Captive or Other)
5
If Any Other (Please specify)

Remarks

Declaration
I certify that I am the authorised person to file the application on behalf of the applicant, and also
certify that the information furnished above is complete and correct in all respects to the best of my
knowledge. In case any information in the application is found to be false or incorrect, then the
application may be deemed to be cancelled without any opportunity of being heard by the
Central/State Government (as the case may be), and the applicant and myself shall be liable for any
penal action for misrepresentation of facts to the Government which tantamount to fraud.

Name and Designation of the Signatory:

Place
Date
Note: The hard copy of the application form shall be signed and stamped on every page by the
authorized person.