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4/9/2019 PaymentForm

(ITP Web Registration Acknowledgment Form - Print in Portrait format on A4 size paper)
Date: 09/04/2019

TIN NO: ACK NO. 125926898G

Name of
:Mr KAPU BALAJI
Applicant

State for
GST :ANDHRA PRADESH
calculation Please affix your
latest Photograph
Date of
:04-May-1999
Birth

:Payment by Online (र 472.0) (Successful online payment received


Mode of
Payment against bank transaction reference number (Trace number):
pay_CHYWGYKgkekQ5E for your NSR web-registration)

Employer
:--
Name
Employee
:-- Signature
Number (Please sign in the centre of the box)

Valid Up
:29/05/2019
To Date

Note :
* To complete your registration please visit any Point of Service (POS) office. If you do not complete your registration
within 50 days of issuance of Acknowledgement Number, your data will be purged from the system.
* You need to take print-out of this form to the POS along-with ORIGINAL proof of Photo Identity [Voter's Id
card/Passport/Driving License/Bank Pass Book (with Photo)/College ID card (not more than 4 years old)/PAN
card/Employment Identity Card].
* NSR registration fee is subject to change as per GST requirement.
* I have read, understood and I agree to the terms and conditions available on NSR website
https:\\nationalskillsregistry.com relating to my joining and using NSR and I agree to the same.

ACKNOWLEDGEMENT SLIP(For the use of POS only)


TIN NO : Ack No : 125926898G
Name of Applicant : Mr KAPU BALAJI POS ID :

1. Received the Application form for Registration as ITP in the National Skills Registry and payment made by
ITP for Registration is Payment through Online.

Date:___________
(POS Seal and Signature)

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