application form for affiliatio n of training ......bank account no. ifsc code micr no. strictly...

PSSC Power Sector Skill Council

APPLICATION FORM FOR

AFFILIATIO

PROVIDERS

SECTOR SKILL COUNCIL


AFFILIATION OF TRAINING

PROVIDERS WITH POWER


1

AANNNNEEXXUURREE--AA


OF TRAINING

OWER



GENERAL INSTRUCTIONS1. A print-out of this application

has to be sent to PSSC by the TP2. Each and every page should be stamped and signed (Authorized Signature) by the

applicant TP. 3. A declaration/board resolution should be furnished by the TP endorsing the

authorized signatory. 4. In addition to hardcopy, please submit the scan copy of the application form and the

requisite supporting enclosures (please scan the application documents after stamping and signing).

5. Any training Batch may be subject to random audi6. The information need to be filled in separately for each centre.7. Fees Structure

Category

1. Training Provider Relationship Fee

2. a) Trainee Certification Fee (Royalty) (Fresh Trainees) b) Trainee re-certification Fee*

3. a) Trainer Certification Fee b) Trainer re-certification Fee c) Training of Trainer

*For RPL cases, the rates will be separately

8. Any other expense towards activity performed, but not reflected

charged separately.

GENERAL INSTRUCTIONS

out of this application form along with hard copies of the relevant documents has to be sent to PSSC by the TP. Each and every page should be stamped and signed (Authorized Signature) by the

A declaration/board resolution should be furnished by the TP endorsing the

In addition to hardcopy, please submit the scan copy of the application form and the requisite supporting enclosures (please scan the application documents after stamping and signing). Any training Batch may be subject to random audit for compliance.The information need to be filled in separately for each centre.

Training Partner Affiliation Fee

Amount in Rupees

Training Provider Rs. 25,000/- Annual per centre

Trainee Certification Fee

Fee

Short-term < 2wks – Rs. 100/-

Short-term 2 to >4 wks – Rs. 150/-

Medium-term 4-6 wks – Rs. 250/-

Long-term >6 wks – Rs. 350/-

Rs. 500/-

Per Trainee certificate

Per Trainee Certificate renewal

Certification Fee

Fee

Rs. 1,500/- with increase of 10% in

5th and 8th year.

Rs. 500/-

*

Per Traine

Per Trainer

*Per Trainer Training on need

basis subject to Actuals

tes will be separately and mutually decided.

Any other expense towards activity performed, but not reflected

2

form along with hard copies of the relevant documents

Each and every page should be stamped and signed (Authorized Signature) by the

A declaration/board resolution should be furnished by the TP endorsing the

In addition to hardcopy, please submit the scan copy of the application form and the requisite supporting enclosures (please scan the application documents after

t for compliance.

Remarks

Annual per centre per occupation

Trainee certificate

Per Trainee Certificate renewal

every 5 years.

Per Trainer certificate

Per Trainer Certificate renewal every 5 years.

*Per Trainer Training on need

basis subject to Actuals

Any other expense towards activity performed, but not reflected above will be


Note: a) Fees are non-refundable; b) Taxes, if applicable, would be over and above the mentioned fee structure; c) All fees are subject to change with prior notice of 90 days;

d) All fee payment has to be made intimated in the affiliation document.e) Please remit Affiliation Fees viconfirmation mail of the payment at

Name of the Bank Address Bank Account No. IFSC Code MICR No.

refundable; ) Taxes, if applicable, would be over and above the mentioned fee structure;) All fees are subject to change with prior notice of 90 days;

has to be made strictly from TPs official bank account as intimated in the affiliation document.

) Please remit Affiliation Fees via NEFT/RTGS details as under and send confirmation mail of the payment at [email protected]

: CANARA BANK : Diplomatic Enclave, New Delhi – 110 021

: 0157101029531 : CNRB0000157 : 110015007

3

) Taxes, if applicable, would be over and above the mentioned fee structure;

official bank account as

NEFT/RTGS details as under and send

110 021

mailto:[email protected]


APPLICATION FOR AFFILIATING FOR THE FOLLOWING JOB ROLES (AS PER QUALIFICATION PACKS):

1. 2. 3.

Section 1: Institution and Management Profile

1. Name of the Institution:

_______________________________________________________

_____________________________________________________

2. Whether NSDC fundedIf Yes, provide details alongwith the supporting documents _____________________________________________________ ____________________________________________________

3. Name/s of the Director/s: ______________________________________________________ ______________________________________________________

4. Contact Details of the Institution:

a. Postal Address:__________________________________________

________________________________________ b. Phone No. with STD code: __________________________ c. Fax No.:_________________________________________ d. Email of the Director/s: _________________________________________________ _________________________________________________ e. Website Address: _________________________________

APPLICATION FOR AFFILIATING FOR THE FOLLOWING JOB QUALIFICATION PACKS):


1. Name of the Institution:

_______________________________________________________

_____________________________________________________

Whether NSDC funded – Yes / No If Yes, provide details alongwith the supporting documents

_____________________________________________________

____________________________________________________

Name/s of the Director/s:

______________________________________________________

______________________________________________________

Contact Details of the Institution:

Address:__________________________________________

________________________________________

Phone No. with STD code: __________________________

Fax No.:_________________________________________

Email of the Director/s:

_________________________________________________

_________________________________________________

Website Address: _________________________________

4


_______________________________________________________

_____________________________________________________

If Yes, provide details alongwith the supporting documents

_____________________________________________________

____________________________________________________

______________________________________________________

______________________________________________________

Address:__________________________________________

________________________________________

Phone No. with STD code: __________________________

Fax No.:_________________________________________

_________________________________________________

_________________________________________________

Website Address: _________________________________


5. Year of Establishment:___________________________________ 6. Prior Exposure of the Institution in Skill Development Space

- NSDC/NSQF Framework- Otherwise

7. Medium of instructions in Institute:

English

Please specify: __________________

9. Details of Self Owned/Franchise(Give separate break-up)

Self Owned

[Attach the list of Training Centres as Enclosure

9. PAN No. and TAN No.

(Attach photocopy of the PAN card and years as Enclosure 2)

10. Turnover of the Institute: ________________________

(Attach Audited balance sheet of last

11. Is the Institute Recognized with any bodies?

12 If Yes, Please mention the following: a. Name of the Body with which recognized: ________________

b. Recognition No.: _____________________________________

c. Year of Recognition: ___________________________________

d. Validity of Recognition: ________________________________

(Attach Recognition certificate as Enclosure 4)

Year of Establishment:___________________________________

Prior Exposure of the Institution in Skill Development Space NSDC/NSQF Framework

7. Medium of instructions in Institute:

Hindi Any Other

__________________

Details of Self Owned/Franchisee/Mobile Training Centres:up)

Franchisee Mobile

Attach the list of Training Centres as Enclosure 1 (Annexure 1.a, 1.b and 1.c)]

PAN No. and TAN No. of the Institute: __________

tocopy of the PAN card and IT returns of last three

Turnover of the Institute: ________________________

(Attach Audited balance sheet of last 3 years as Enclosure 3)

Recognized with any bodies? Yes

If Yes, Please mention the following:

Name of the Body with which recognized: ________________

Recognition No.: _____________________________________

Year of Recognition: ___________________________________

Validity of Recognition: ________________________________

(Attach Recognition certificate as Enclosure 4)

5

Year of Establishment:___________________________________

Prior Exposure of the Institution in Skill Development Space

Any Other

/Mobile Training Centres:

Total

1 (Annexure 1.a, 1.b and 1.c)]

of last three

Turnover of the Institute: ________________________

as Enclosure 3)

Yes No

Name of the Body with which recognized: ________________

Recognition No.: _____________________________________

Year of Recognition: ___________________________________

Validity of Recognition: ________________________________


13. Is the Institute Affiliated Yes No

14. If Yes, Please mention the following:

a. Name of the Regulatory Body with which affiliated:

________________________________________________

b. Affiliation No.: _____________________________________

c. Year of Affiliation: ___________________________________d. Validity of affiliation:_________________________________

(Attach Affiliation certificate as Enclosure 5)

15. Educational Qualifications and Experience of the Director/s and the Management Team members

Name of the EducationalDirector/ Qualifications

Management

Team

Members

Institute Affiliated with any Regulatory Body?

If Yes, Please mention the following:

Name of the Regulatory Body with which affiliated:

________________________________________________

Affiliation No.: _____________________________________

Year of Affiliation: ___________________________________affiliation:_________________________________

(Attach Affiliation certificate as Enclosure 5)

Educational Qualifications and Experience of the Director/s and the Management Team members

Educational Overall Prior

Qualifications Work ExperienceExperience in the

(in years) Skills

Training

Space

6

Name of the Regulatory Body with which affiliated:

________________________________________________

Affiliation No.: _____________________________________

Year of Affiliation: ___________________________________ affiliation:_________________________________

Educational Qualifications and Experience of the Director/s

Key

Experience Achievements

in the Skills

Development

Training


16. Details of the Operation Head and the Affiliation Coordinator of the TP

Name of Educationalthe Qualifications

Operations

Head and

Affiliation

Coordinator

17. Provide the Contact Details of the Directors/ Management Team/ Operations Head/ Affiliation Coordinator

Name Contact Address

Details of the Operation Head and the Affiliation Coordinator of the TP

Educational Overall Prior

Qualifications Work ExperienceExperience in the

(in years) Skills

Training

Space

Provide the Contact Details of the Directors/ Management Team/ Operations Head/ Affiliation Coordinator

Contact Address Contact Numbers

– Both Land Line

and Mobile

7

Details of the Operation Head and the Affiliation

Key

Experience Achievements

in the Skills

Development

Provide the Contact Details of the Directors/ Management

Email-ids


Section 2: Quality Aspects in Institution Governance

18. Does your Institution have a “Mission Statement”?

Yes

19. If Yes, please write the Mission Statement in the space provided below:

20. Does your Institution have as “Operations Manual”?

Yes

21. Please certify if your “Operational Manual” cover the aspects mentioned below in the table. At the time of affiliationassessment, the Operations Manual will have to be for physical verification.

Aspect

Background of the Institution

Organization Structure

Details of other Affiliations, if

Industry/Employer Linkages

Profile of Senior and Middle

Profile of trainers

Details of Infrastructure, workshop,

store etc.

Process of internal evaluation

Placement cell details and it

record

Courses offered


18. Does your Institution have a “Mission Statement”?

No

If Yes, please write the Mission Statement in the space provided


No

Please certify if your “Operational Manual” cover the aspects mentioned below in the table. At the time of affiliationassessment, the Operations Manual will have to be for physical verification.

Aspect Yes/No

Background of the Institution

Details of other Affiliations, if applicable

Linkages

Profile of Senior and Middle Management

Details of Infrastructure, workshop,

Process of internal evaluation

Placement cell details and its placement track

8


If Yes, please write the Mission Statement in the space provided


Please certify if your “Operational Manual” cover the aspects mentioned below in the table. At the time of affiliation assessment, the Operations Manual will have to be presented

Remarks


22. In the space provided below, provide the financial

resources which

vocational educational program consistent with its stated

mission and objectives.

23. Provide the list of all statutory and regulatory compliances followed by the Institution.

In the space provided below, provide the financial

resources which shall be capable of sustaining a sound


mission and objectives.

Provide the list of all statutory and regulatory compliances followed by the Institution.

9

In the space provided below, provide the financial

shall be capable of sustaining a sound


Provide the list of all statutory and regulatory compliances


Section 3: Training Operations

24. Details of documented process for management of Human Resources. Certify the existence of the aspects listed below and will have to be physically produced to the affiliation assessors.

AspectRecruitment guidelines and criteria basedon required competencies

Process of reviews to identify competencygaps vis-à-vis requirement in the intalent

Training and professional developmentplan and processes

Maintaining records of qualifications andexperience

Process of motivation and enhancementof self-esteem amongst the staff

25. PSSC Specific (Attach CVs of all the teaching staff as Enclosure 11)

S. N Name Designation

Section 3: Training Operations – Processes

Details of documented process for management of Human Resources. Certify the existence of the aspects listed below and will have to be physically produced to the affiliation

Aspect Yes/No

Recruitment guidelines and criteria based

on required competencies

Process of reviews to identify competency

vis requirement in the in-house

Training and professional development

of qualifications and

Process of motivation and enhancement

esteem amongst the staff

PSSC Specific - Details of the Teaching Staff. Attach CVs of all the teaching staff as Enclosure 11)

Degree/ Training Industry

Diploma Certificate Experience

10

Processes

Details of documented process for management of Human Resources. Certify the existence of the aspects listed below and will have to be physically produced to the affiliation

Remarks

Instruction Regular/

Experience Visiting


26. Have the Trainers undergone any specialized training?

Yes

(If Yes, attach the Detail

27. Administrative Support Staff.

S. StaffNo.

1. Office Manager

2. Office Staff

3. Lab Attendants

4. Accountant

5. Support Staff

6. Others

28. Details of the Curriculum of all the courses offered. Certify

the existence of the aspects listed below and will have to be

physically produced to the affiliation assessors.

AspectProcess of adoption and/or developmentof curriculum on the basis of QP and NOSdeveloped by PSSC

Review process to gauge the effectivenessof the curriculum developedClear demarcation of time to theory andpractical as per the criteria set byregulatory bodies

Pedagogy inclusive of time schedule andlesson plan

Process of SME engagement in curriculumdesign and development

Review process for approval of curriculumfrom PSSC


Yes No

(If Yes, attach the Details of the training as Enclosure 12

Administrative Support Staff.

Staff Permanent Temporary/Part

Office Manager

Office Staff

Lab Attendants

Accountant

Support Staff



produced to the affiliation assessors.

Aspect Yes/No

adoption and/or development

of curriculum on the basis of QP and NOS

Review process to gauge the effectiveness

of the curriculum developed

Clear demarcation of time to theory and

practical as per the criteria set by

Pedagogy inclusive of time schedule and

Process of SME engagement in curriculum

design and development

Review process for approval of curriculum

11


s of the training as Enclosure 12)

Temporary/Part-Time Total



Remarks


29. Details of the Courseware of all the

existence of the aspects listed below and will have to be physically

produced to the affiliation assessor

Aspect

Process of adoption and/or development of

content/courseware on

NOS based curriculum approved by PSSC

Existence of Facilitators Guide

Existence of Trainer Guide

Existence of Participant Manuals

Existence of Assessment Guides

Existence of Participant Feedback Forms

Existence of Training Delivery Plans


of the courseware developed

Process of SME engagement in courseware


Review process for approval of courseware

by PSSC

Declaration of conducting PSSC

training for Participant with the list of

identified stores mapped to each training

centre

29. Details of the Courseware of all the courses offered. Certify the


produced to the affiliation assessors/subsequent learner assessors.

Aspect Yes/No

Process of adoption and/or development of

content/courseware on the basis of QP and

NOS based curriculum approved by PSSC

Existence of Facilitators Guide

Existence of Trainer Guide

Existence of Participant Manuals

Existence of Assessment Guides

Existence of Participant Feedback Forms

Training Delivery Plans


of the courseware developed

Process of SME engagement in courseware


Review process for approval of courseware

Declaration of conducting PSSC specific

training for Participant with the list of

identified stores mapped to each training

12

courses offered. Certify the


s/subsequent learner assessors.

Remarks


30. Details of the Teaching Process for the courses offered. Certify the existence of the aspects listed below and will have to be physically produced to the affiliation assessors.

AspectTime table

Delivery plan

Monitoring and evaluation process ofstudents – continuous assessments, tests,

examination etc.

Management of student evaluationrecords

Lab/ workshop exposure and its linkage totheoretical delivery

Industry visits

31. Details of Training Methodology. Certify the existence of the

aspects listed below and will have to be physically produced to the

affiliation assessors.

Aspect

Documentation process of training methodology Existence of training aids

32. Details of Methodology adopted for Continuous Evaluation.

Certify the existence of the aspects listed below and will have to be


Aspect Documentation process of ContinuousEvaluation Documented process on student monitoring on learning

30. Details of the Teaching Process for the courses offered. Certify the existence of the aspects listed below and will have to be physically produced to the affiliation assessors.

Aspect Yes/No

Monitoring and evaluation process of

continuous assessments, tests,

Management of student evaluation

Lab/ workshop exposure and its linkage to



Aspect Yes/No

mentation process of training

Existence of training aids




Aspect Yes/No

Documentation process of Continuous

student monitoring on learning

13

30. Details of the Teaching Process for the courses offered. Certify the existence of the aspects listed below and will have to be

Remarks



Remarks



Remarks


33. Details of Methodology adopted for Industrial Interface.



Aspect Documentation process of engagement of experts from the industry Documented process on integration of real life problems from the industry and exposing students sample solutions

34. Details of Methodology adopted for Student Development.



Aspect Documented process of imparting soft skills training Documented process of providing guidance to students on placements Documented process on OJT/ Placement facilitation

35. Details on Student Admissions. Certify the


affiliation assessors.

Aspect Printed brochure/ prospectus Documented policy and procedures for admissions Concessions policy Process of keeping the safe custody of student documents Student agreement with the institution at the time of admission

33. Details of Methodology adopted for Industrial Interface.



Aspect Yes/No

Documentation process of engagement of experts from the industry

Documented process on integration of real life problems from the industry and exposing students sample solutions




Aspect Yes/No

Documented process of imparting soft

Documented process of providing guidance to students on placements

Documented process on OJT/ Placement

35. Details on Student Admissions. Certify the existence of the


Aspect Yes/No

Printed brochure/ prospectus

Documented policy and procedures

keeping the safe custody

Student agreement with the institution

14

33. Details of Methodology adopted for Industrial Interface. Certify


Remarks



Remarks

existence of the


Remarks


36. Provide the availability of aspects related to the Learnin

Aspect Are the classroom illumination levels sufficient? Are the classroom ventilated enough Do the classroom and rest of the centre maintain the required cleanliness? Do the classroom and rest of the centre weather protected

37. Library details

a. Total number of Books related to the trade: Technical: __________________ Non-Technical: ______________

b. Number of Magazine: _______________________ c. Number of Dailies (newspapers): ______________

38. Provide the details of related to Infrastructure:

Building Own/Rented/On LeaseArea of Institute Premises

Size of classrooms

Size of Labs Size of workshops

Number of classroomsNumber of Labs

Number of workshopsSafe drinking water (yes/no)

Power backup (yes/no)

Separate toilet for Boys and Girls (yes/no)Provision of transport facility, if applicable (yes/no)

Any other, please specify

36. Provide the availability of aspects related to the Learning Environment:

Aspect Yes/No

Are the classroom illumination levels

Are the classroom ventilated enough

Do the classroom and rest of the centre cleanliness?

Do the classroom and rest of the centre

Total number of Books related to the trade: Technical: __________________

Technical: ______________ Number of Magazine: _______________________ Number of Dailies (newspapers): ______________

details of availability of the following related to Infrastructure:

Aspect Details

Building Own/Rented/On Lease Area of Institute Premises

Number of classrooms

Number of workshops drinking water (yes/no)

Power backup (yes/no)

Separate toilet for Boys and Girls (yes/no) Provision of transport facility, if applicable (yes/no)

Any other, please specify

15

g Environment:

Remarks

Number of Magazine: _______________________ Number of Dailies (newspapers): ______________

the following aspects

Details Remarks


39. Ages of Critical Equipment that are more extensively used for Trade Training in the Workshop

S. No. Trade

40. Details on Health and Safety of the learners. Certify the

existence of the aspects listed below and will have to


AspectDocumented process of staff training on crisis handling Availability of equipment required for covering indoor and outdoor emergenciesDocumented process on providing equipment on indoor and outdoor emergenciesAvailability of equipment required for fire safety

Documented process on providing training on the fire safety equipment

Health policy including collections of required medical record of staff and students

Compliance to the regulatory norms related to health and sanitary conditions

Documentary proof of compliances certified by the competent authority

39. Ages of Critical Equipment that are more extensively used for Trade Training in the Workshop

Facilities No. Average age

in No. of Years


existence of the aspects listed below and will have to


Aspect DetailsDocumented process of staff training on crisis

Availability of equipment required for covering indoor and outdoor emergencies

Documented process on providing training on the equipment on indoor and outdoor emergencies

Availability of equipment required for fire safety

Documented process on providing training on the

Health policy including collections of required staff and students

Compliance to the regulatory norms related to health and sanitary conditions

Documentary proof of compliances certified by the

16

39. Ages of Critical Equipment that are more extensively used

Average age Remarks

in No. of Years


existence of the aspects listed below and will have to be

Details Remarks


Section 4: Performance Measurement andImprovement

41. Documentary evidences of suitable indicators to monitor and

measure the performance. Key aspects that need to be certified by

the applicant are:

Aspect

Documented process of trade learning progressDocumented processes of workshop upkeep and modernization Documented process on tracking health and safety incidences Documented process on gathering feedback of placed students with the employersDocumented process of tracking trends in employability and placement record

42. Documentary evidences of practicing continual improvement. Key aspects that need to be certified by the applicant are:

AspectDocumented process of taking studentfeedback on curriculum

Documented processes of taking studentattendance

Documented process on tracking studentdropouts

Documented process on tracking studentperformance on tests

Documented process of tracking teacherattendance

Documented process of trackingplacement patterns

Section 4: Performance Measurement and

evidences of suitable indicators to monitor and


Aspect Details

Documented process of trade learning progress Documented processes of workshop upkeep and

Documented process on tracking health and safety

Documented process on gathering feedback of placed students with the employers

Documented process of tracking trends in employability and placement record

Documentary evidences of practicing continual improvement. Key aspects that need to be certified by the applicant are:

Aspect Yes/No

Documented process of taking student

Documented processes of taking student

Documented process on tracking student

Documented process on tracking student

Documented process of tracking teacher

Documented process of tracking

17

evidences of suitable indicators to monitor and


Details Remarks

Documentary evidences of practicing continual improvement. Key aspects that need to be certified by the applicant are:

Remarks


43. Documentary evidences of Management Review. Key aspects that need to be certified by the applicant are:

Aspect

Documented process of conduction of Management Review Meetings (MRM)

Documented processes of taking actions on the basis of MRM

Documented process on tracking Faculty ReviewDocumented process on tracking training needs of the faculty by the managementDocumented process of tracking student complaints and redress of the same Documented process of analysis of feedback Documented process of analysis of results in skills assessment

44. Documentary evidences of mechanism on ComplaintHandling. Key aspects that need to be certified by the applicant are:

AspectDocumented process on InformationSharing on complaints with allstakeholders

Documented processes ofacknowledgement of receipt of complaint

Documented process on investigation ofthe student complaint

Documented process of tracking trainingneeds of the faculty by the management

Documented process of tracking studentcomplaints and redress of the same

Documented process of closure of thestudent complaint

Documented process of keeping record ofstudent complaint

Documentary evidences of Management Review. Key aspects that need to be certified by the applicant are:

Aspect Details

Documented process of conduction of Management

Documented processes of taking actions on the

Documented process on tracking Faculty Review Documented process on tracking training needs of the faculty by the management

Documented process of tracking student complaints

Documented process of analysis of student

Documented process of analysis of results in skills

44. Documentary evidences of mechanism on ComplaintKey aspects that need to be certified by the

Aspect Yes/No

process on Information

Sharing on complaints with all

Documented processes of

acknowledgement of receipt of complaint

Documented process on investigation of

Documented process of tracking training

needs of the faculty by the management

Documented process of tracking student

complaints and redress of the same

Documented process of closure of the

Documented process of keeping record of

18

Documentary evidences of Management Review. Key aspects

Details Remarks

44. Documentary evidences of mechanism on Complaint Key aspects that need to be certified by the

Remarks


Other Relevant Information

45. Does the Institute receive any grant from Govt. of India / State Government/ Union Territory or any other source?

(Attach details of grants received in last 3 years as Enclosure

Other Relevant Information

45. Does the Institute receive any grant from Govt. of India / State Government/ Union Territory or any other

(Attach details of grants received in last 3 years as Enclosure

19

India / State Government/ Union Territory or any other

(Attach details of grants received in last 3 years as Enclosure 17)


Performance Review a. Overall

SNo. Performance Criteria

1. Utilization of Students seating capacity

2. Retention Rate (Of students admitted)

3. Students/Teaching Staff

4. Pass out (of students appeared)

5. Students on completion got jobs

6. Total yearly expenditure/initial budget sanctioned

7. Students on completion expressing satisfaction on quality of training

8. Teachers expressing satisfaction on all round conditions of the VTP

Performance Review

Unit of Measurement

2014-15 2013-14

%

%

Ratio

%

%

%

%

%

20

2012-13 Remarks


b. Tradewise

SNo. Course Name Duration

46. Please find enclosed the Demand

________________ for Rs drawn on __________ payable at New Delhi towards the application fees.

Declaration I hereby declare the above information is true and correct as per my knowledge.

Name: ___________________________________

Designation: ______________________________

Duration No. Of batch/year

Students in each batch

No. Of trainees

appeared for Exam

enclosed the Demand Draft/Cheque no. ________________ for Rs. _______________ dated _____________

drawn on __________ in favour of “Power Sector Skilltowards the application fees.

declare the above information is true and correct as per my

Authorise(With Official Seal)

Name: ___________________________________

Designation: ______________________________

21

No. Of trainees

appeared for Exam

No. Of trainees placed

Remarks

_______________ dated _____________

Sector Skill Council”,

declare the above information is true and correct as per my

Authorised Signatory

(With Official Seal)


SNo. 1. List of Branches

2. PAN and IT Return

3. Audited Balance Sheet4. Registration Certificate of Trust/Society

5. Copy of Recognition Certificate6. Copy of Affiliation Certificate

7. All Proof of Delivery of Govt. (Central/State/U.T.) sponsored skilling programs in last two years till 31

8. Building Approval Document

9. Staff Particulars 10. CVs of the Teaching/Training Staff

11. Training detail of Staff12. Drinking Water

13. Health and Sanitary Conditions14. Fire Safety

15. Bus Service Details

16. Details of Grants received in last 3 years17. Details of physical infrastructure i.e. no. and capacity of

classroom with audio visual facilities, workshop laboratories, library hostels, etc. A brief writephotographs to be attached.

List of Enclosures

PAN and IT Return

Audited Balance Sheet Registration Certificate of Trust/Society

Copy of Recognition Certificate Copy of Affiliation Certificate

Delivery of Govt. (Central/State/U.T.) sponsored skilling programs in last two years till 31st March 2015

Building Approval Document

CVs of the Teaching/Training Staff

of Staff

Health and Sanitary Conditions

Bus Service Details

Details of Grants received in last 3 years Details of physical infrastructure i.e. no. and capacity of classroom with audio visual facilities, workshop laboratories, library hostels, etc. A brief write-up with photographs to be attached.

22

Enclosed Yes / No

Yes / No

Yes / No Yes / No

Yes / No Yes / No

Delivery of Govt. (Central/State/U.T.) sponsored Yes / No

Yes / No

Yes / No Yes / No

Yes / No Yes / No

Yes / No Yes / No

Yes / No

Yes / No Details of physical infrastructure i.e. no. and capacity of classroom with audio visual facilities, workshop

up with

Yes / No


To, The Chief Executive Officer (CEO)Power Sector Skill CouncilPlot No. 4, Institutional AreaCBIP Building, Malcha MargChanakyapuri New Delhi – 110 021

Respected Sir, This is to declare our Staff

Name of the Employees Designation

Thank you. Yours, (Sign and Stamp) Name Designation Contact Number

(Annexure 2 on letter head)

The Chief Executive Officer (CEO) Power Sector Skill Council Plot No. 4, Institutional Area CBIP Building, Malcha Marg

Sub.: Undertaking of Staff Details

This is to declare our Staff Details.

Designation Employees Category (Permanent/Temporary/Contract)

23

Date:

Employees Category (Permanent/Temporary/Contract)



Sub.: Undertaking of

Respected Sir, This is to declare our self

SNo. Name of the Centre

Location

Please find enclosed the Lease/Rent/Sale agreement of the above mentioned along with this declaration. We confirm that all the details provided in this declaration is correct, updated and as per our best knowledge. Thank you. Yours, (Sign and Stamp) Name Designation Contact Number

(Annexure 1.a on letter head)

Executive Officer (CEO) Power Sector Skill Council Plot No. 4, Institutional Area CBIP Building, Malcha Marg

Sub.: Undertaking of Self Owned Centres

self-owned and self-operated centres, as detailed below:

Location Address Centre Head

Centre Head Contact details

Please find enclosed the Lease/Rent/Sale agreement of the above mentioned along with this declaration.

We confirm that all the details provided in this declaration is correct, updated and as per our best knowledge.

24

Date:

centres, as detailed below:-

Contact details Centre Coordinator

Contact details

Please find enclosed the Lease/Rent/Sale agreement of the above mentioned centres

We confirm that all the details provided in this declaration is correct, updated and as



Sub.: Undertaking of

Respected Sir, This is to declare our franchisee


Location

Please find enclosed the with this declaration. We confirm that all the details provided in this declaration is correct, updated and as per our best knowledge. Thank you. Yours, (Sign and Stamp) Name Designation Contact Number

(Annexure 1.b on letter head)


Sub.: Undertaking of Franchisee (Centres)

franchisee centres, as detailed below:-



Please find enclosed the franchisee agreement of the above mentioned centres along


25

Date:


Contact details

mentioned centres along




Respected Sir, This is to declare our mobile centres, as detailed below:


Location

Please find enclosed the mobile agreement of the above mentioned with this declaration. We confirm that all the details provided in this declaration is correct, updated and as per our best knowledge. Thank you. Yours, (Sign and Stamp) Name Designation Contact Number

(Annexure 1.c on letter head)


Sub.: Undertaking of Mobile (Centres)

mobile centres, as detailed below:-



Please find enclosed the mobile agreement of the above mentioned


26

Date:


Contact details

Please find enclosed the mobile agreement of the above mentioned centres along



SNo. List of Documents

1. Cover Letter

2. Application Form

3. List of Branches

4. PAN and IT Return

5. Audited Balance Sheet of Last

6. Registration Certificate of Trust/Society

7. Building Approval Document

8. Staff Particulars

9. CVs of the Teaching/Training Staff

10. Training detail of Staff

11. Drinking Water Facilities Details

12. Health and Sanitary Conditions

13. Fire Safety Facilities Details

14. Bus Service Facilities Details

15. MoU

16. Previous Training Record

17. Copy of Recognition Certificate

18. Copy of Affiliation Certificate

19. All Proof of Delivery ofsponsored skilling programs in last two years till August 15th 2015

20. Details of Grants received in last three years

Request to arrange all the document -

Affiliation Document Checklist

List of Documents Enclosed

Yes / No

Yes / No

Yes / No

Yes / No

Audited Balance Sheet of Last Three Years Yes / No

Registration Certificate of Trust/Society Yes / No

Building Approval Document Yes / No

Yes / No

CVs of the Teaching/Training Staff Yes / No

Yes / No

Facilities Details Yes / No

Health and Sanitary Conditions & Facilities Details Yes / No

Facilities Details Yes / No

Details Yes / No

Yes / No

Previous Training Record Yes / No

Copy of Recognition Certificate Yes / No

Copy of Affiliation Certificate Yes / No

All Proof of Delivery of Govt. (Central/State/UT) sponsored skilling programs in last two years till

Yes / No

Details of Grants received in last three years Yes / No

Request to arrange all the documents as per the above mentioned sequence

27

Nature of Documents

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

as per the above mentioned sequence


This is to inform that Training Provide

Council (PSSC) may please note that

Rs. 25,000/- Annual Per C

Form for Affiliation of the Training Providers with

at point no. 7 (1) under General Instruction

25,000/- Annual Per Centre.

CORRIGENDUM

Training Providers willing to affiliate with Power Sector Skill

please note that Training Providers Relationship

Centre Per Occupation in the document on

Training Providers with Power Sector Skill Council (PSSC)”

under General Instructions of Page no. 2 stands corrected as Rs.

Annual Per Centre.

28

15th June 2015

Power Sector Skill

elationship Fee indicated as

ccupation in the document on “Application

r Sector Skill Council (PSSC)”

age no. 2 stands corrected as Rs.

Chief Executive Officer