FORMAT FOR CLAIMING COURSE FEES BY TRAINING PARTNER

General Details of Training Partner:

Name of Scheme Enrolled
(Select Any One) Skill Development in ESDM for Digital India (Scheme 2)
Name of Training Partner (TP) Alcyone Consultancy Services Pvt. Ltd.
ESDM TP ID ESDM-UK2-TP-000016
Name of State Uttrakhand (Scheme2)
Name of KIA Telecom Sector Skill Council
Name of Course Handset repair Engineer (Level II)
Course Code TL/S/L4/C003
Course Level L4
Course Fees 1500
Batch ID BATCH-UK2-03914
Batch Start Date 25/05/2016
Batch End Date 26/07/2016
Batch Size 24
Number of students appeared 24
Number of students passed 24
Exam Date 16/08/2016
Result Date 07/09/2016
PAN no. AAMCA2812R
Service Tax Registration no. AAMCA2812RSD002
a) Name of Bank: Induslnd bank
b) Branch Name: Preet Vihar Branch C-61, Preet Vihar Vikash Marg, New
Delhi- 110092.
c) Account number: 201000813511
d) Account Type: Current
e) IFSC Code: INDB0000031
Bank Details of TP f) MICR Code: 400234002
General Details of Students:

No. Student Name Category Aadhaar No. Result Placement

Pass / Claim(Rs.) Placed for Claim
fail 2 months (Rs.)
1 HIMNSHU GEN 624277391288 Pass 1125
2 VISHAL TYAGI GEN 757142406327 Pass 1125
3 MOHIT KUMAR GEN 429300022372 Pass 1125
4 PRASHANT KUMAR GEN 999246950744 Pass 1125
5 NEERAJ KUMAR GEN 622857685694 Pass 1125
6 DHARAMRAJ KUMAR GEN 365486265487 Pass 1125
7 RAJAT KUMAR GEN 572604046405 Pass 1125
8 RAHUL KUMAR GEN 811403931168 Pass 1125
9 MOHIT KUMAR GEN 649575110975 Pass 1125
10 DEEPAK KUMAR GEN 857849698287 Pass 1125
11 SUMIT KUMAR GEN 697032728972 Pass 1125
12 AJAY KUMAR GEN 244453292083 Pass 1125
13 TANVEER AHMAD GEN 543877755200 Pass 1125
14 RAVINDRA KUMAR GEN 408372403520 Pass 1125
15 RAJNISH KUMAR GEN 675274256820 Pass 1125
16 PARVEJ ALI GEN 459467181947 Pass 1125
17 AVNISH KUMAR GEN 422276783854 PASS 1125
18 MOHIT KUMAR GEN 822852894027 Pass 1125
19 AMIT KUMAR GEN 870525435900 Pass 1125
20 MAHESHWAR GEN 715434740602 Pass 1125
21 SANDEEP KUMAR GEN 910579050750 Pass 1125
22 ANIL KUMAR GEN 605074963092 Pass 1125
23 BHOLA RAM GEN 491140971053 Pass 1125
24 DEEPAK KUMAR GEN 452413775374 Pass 1125
Total Total Total Claim Total Total
pass (Rs.27000) placed Claim
-24 (Rs.) (Rs.)
 1. Certified that the above data/information matches with the details/data
available on ESDM Portal.

2. All the points mentioned in the check list enclosed as Annexure A have been
complied with.

Authorized Signatory

Date: 18/10/2016 Name: J.B.CHAKRABORTY

Designation: DIRECTOR
Office Seal:
 ANNEXURE-A

Check list for submission of Invoice with supporting documents by training partners(TPs) for
Reimbursement/Payment of Course fee to training Partner(TPs).

1. Whether covering letter on Official letter head of Training Partner.

2. Whether Invoice Addressed to PMU at the below indicated address.
Principal Consultant,
ESDM-PMU, NIELIT
C/O __________________
National Institute of Electronics and Information Technology
ELECTRONICS NIKETAN
6, CGO COMPLEX, LODI ROAD
NEW DELHI-110003.

3. Whether Invoice having Reference Number

4. Whether Invoice having date
5. Whether invoice indicates description of Work (for which invoice is generated)
6. Whether invoice indicates total amount of invoice.
7. Whether Signature and Stamp of authorized signatory on each page has been done.
8. Whether First page mentions total number of pages submitted duly signed and stamped.
9. Whether claim in prescribed format with supporting documents duly signed & stamped is
attached.
10. Whether copy of attendance sheet in the class room/practical etc. duly signed is attached.
11. Whether (i) copy of caste/income certificate w.r.t SC/ST/EWS candidates and (ii) copy of
pass certificate of student(s) duly attested is attached in case this claim is for payment of
first installment of 50%.
12. Whether (i) copy of paid invoice of first installment of 50%, if applicable. (ii) Self
employment Certificate/Offer letter of appointment (iii) copy of income certificate/salary
slip for (ii) above (iv) copy of bank account statement (mandatory for salaried employment)
showing transactions for two months.
13. Whether copy of (i) PAN card duly attested and (ii) copy of blank cheque enclosed.
(Applicable for first time payment only)
 FORMAT TO BE SUBMITTED BY TRAINING PARTNER (TP) FOR TRANSFER OF
REGISTRATION-CUM-CERTIFICATION FEES TO TP IN RESPECT OF STUDENTS
ENROLLED ON OR AFTER 1st APRIL 2015.

General Details of Training Partner:

Name of Scheme Enrolled

(Select Any One) Skill Development in ESDM for Digital India (Scheme 2)
Name of KIA Telecom Skill Council
Name of State Uttrakhand(Scheme2)
Name of Training Partner (TP) Alcyone Consultancy Services Pvt. Ltd
ESDM TP ID ESDM-UK2-TP-000016
Name of Course Handset repair Engineer(Level II)
Course Code TL/S/L4/C003
Course Level L4
Registration-cum-Certification
Fees 1500
Batch ID BATCH-UK2-03916
Batch Start Date 25/05/2016
Batch End Date 26/07/2016
Batch Size 22
Number of students appeared 22
Number of student passed 22
Exam Date 17/08/2016
Result Date 07/09/2016
PAN no AAMCA2812R
Service Tax Registration no AAMCA2812RSD002
a) Name of Bank: Induslnd bank
b) Branch Name: Preet Vihar Branch, C-61, Preet Vihar Vikash Marg, New
Delhi-110092.
c) Account number: 201000813511
d) Account Type: Current
e) IFSC Code: INDB0000031
f) MICR Code: 400234002
Bank Details of TP
General Details of Students
No. Student Name Category Aadhaar No. Result
Pass / fail Claim (Rs.)
1 ANKUR GEN 250649287751 Pass 1125
2 RAVISH GEN 752244713055 Pass 1125
3 NITIN GEN 629581700856 Pass 1125
4 RAJAT GEN 288898888919 Pass 1125
5 KURBAN ALI GEN 521602353726 Pass 1125
6 SANYAM GEN 480753894398 Pass 1125
7 MOHIT GEN 210762436829 Pass 1125
8 RAJVEER SINGH GEN 577863187710 Pass 1125
9 SHUBHAM GEN 825443348663 Pass 1125
10 PRAVEEN KUMAR GEN 368053462456 Pass 1125
11 TOUFIK ALI GEN 599452359557 Pass 1125
12 RAHUL GEN 458046023622 Pass 1125
13 UJJWAL GEN 696347472604 Pass 1125
14 SACHIN KUMAR GEN 619901845262 Pass 1125
15 VIKASH GEN 970963373444 Pass 1125
16 AKSHAY GEN 405410914903 Pass 1125
17 PUSHPENDRA GEN 754175357545 PASS 1125
18 DEEPAK KUMAR GEN 729464081666 Pass 1125
19 DIMPAL KUMAR GEN 678609942937 Pass 1125
20 RAVI KUMAR GEN 798908644006 Pass 1125
21 KULDEEP KUMAR GEN 736571964743 Pass 1125
22 VINIT KUMAR GEN 556136885900` Pass 1125
Total Total Pass Total
22 Claim(Rs.)
24750
 1. Certified that the above data/information matches with the details/data
available on ESDM Portal.

2. All the points mentioned in the check list enclosed as Annexure C have been
complied with.
Authorized Signatory

Date: 26/10/2016 Name: J.B.Chakraborty

Designation: Director
Office Seal:
ANNEXURE-C

Check list for submission of Invoice with supporting documents by Training Partners (TPs)
for transfer of Registration-cum-Certification fee to TPs in respect of students enrolled on or
after 1st April, 2015).

1. Whether covering letter on Official letter head of TP.

2. Whether Invoice Addressed to PMU at the below indicated address.
Principal Consultant,
ESDM-PMU, NIELIT
C/O __________________
National Institute of Electronics and Information Technology
ELECTRONICS NIKETAN
6, CGO COMPLEX, LODI ROAD
NEW DELHI-110003.

3. Whether Invoice having Reference Number

4. Whether Invoice having date
5. Whether invoice indicates description of Work (for which invoice is generated)
6. Whether invoice indicates total amount of invoice.
7. Whether Signature and Stamp of authorized signatory on each page has been done.
8. Whether First page mentions total number of pages submitted duly signed and stamped.
9. Whether claim in prescribed format with supporting documents duly signed & stamped is
attached.
10. Whether copy of pass certificate of student(s) duly attested is attached.
11. Whether copy of caste/income certificate in respect of SC/ST/EWS duly signed is attached.
12. Whether copy of (i) PAN card duly attested and (ii) copy of blank cheque enclosed.
(Applicable for first time payment only)