ANNEXURE-III REVISED
SELF-DECLARATION (To be submitted to the SDO/ Joint Director of Employment,
Kolkata after every six months)
ENROLLMENT NO: ……………………..
I Sri/ Smt …………………………………………, Son/Daughter/Wife of
Sri…………………………..
a recipient of Unemployment Assistance under YUVA UTSAHA PRAKALPA-2013 is
unemployed till date and I am utilizing the Unemployment Assistance to undertake training for
increasing my employability.
Note : All the fields below are mandatory and must be filled in properly
Sl.No. Name/Nature of training Name and address
of training
institute
Date of initiation
and duration of
training
Remarks
I shall be liable for penal action as per law in case this declaration is proved to be false
subsequently.
Date:
Place: Signature in full
Name of the beneficiary:
