Annex A
IT- ITeS SSC Scheme for Endorsement of IT Training Courseware
IT CoursewareAttestation Scheme
Application Form for Attestation of IT Training Courseware
1) / Name of the IT Training Courseware Developer: /2) / Address of the IT Training Courseware Developer : /
3) / Telephone Number : /
4) / Email details : /
5) / Legal entity status:
Pvt. Ltd / Public Ltd/ Govt/ Trust etc. /
6) / Other functions performed by the IT Training Courseware Developer: /
7) / Are you a part of a larger corporation: /
8) / If yes please indicate the relationship with the larger corporation : /
9) / Details of the valid licence/registration /
QCI/IT SSC CAP 01/ Ver. Dec. 13Page 1 of 6
10)Details of IT Training Courseware for which attestation is being sought (as applicant):
S. No / Title of the IT Training Courseware / Revision status / Date of Original Issue / Qualifications Pack Code / Job Role / Applicable National Occupational Standardnumber / Details of the environment, platform and tools etc / Duration of CourseCode / Version No. / Weeks/ Months / Teaching hours
QCI/IT SSC CAP 01/ Ver. Dec. 13Page 1 of 6
11)Has the IT Courseware for which attestation is being sought been submitted earlier to QCI ? : Yes / NO
If Yes, please provide the following details;
a)Date when submitted to QCI:
b)Details of the IT Courseware with Revision Status (Version / Issue number):
c)Outcome of the Application along with details of dates:
12)Ownership of authorship of Courseware (Attach Undertaking as per Appendix A):
13)Self Evaluation Checklists duly filled for every NOS of the QP for which attestation has sought (Attach filled Checklists as per Appendix B) .
Attachments:
Appendix AUndertaking from the IT Courseware Developer about the Courseware Ownership
Appendix BFormat for Checklist based on NASSCOM Checklist
Dated: Signature
Name and Designation
Courseware Developer
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Appendix A to Annex A
IT- ITeS SSC Scheme for Endorsement of
IT Training Courseware
Undertaking from the IT Courseware Developer about the Courseware Ownership
This is to confirm that the courseware ______(write the name of courseware along with version number) prepared for training for Qualification Pack Code ______(Qualification Packs Code Number) and Job Role ______(write the Job Role) submittedfor Attestation and subsequent endorsement by IT ITeS SSC by ______( write name of Courseware Developer) is my/ our original work, and has been registered under “Copy Right Act” vide application filed and reference no ______dated ______and has not been copied, partially or completely from anywhere.
In case I have used some published material for reference, in the courseware, the reference of the same is given in bibliography of the courseware and permission to use the same has been taken from the author of the publication.
This is also to confirm that in case the courseware infringes the IPR, then I would be liable for the same.
Dated: Signature
Name and Designation of
Courseware Developer
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Appendix B to Annex A
Format for Checklist based on NASSCOM Checklist
NOS / Outcomes / Performance Ensuring Measures / Duration (Hrs) / Work Environment / Lab Requirement (Inclusive of Hardware / Software Specifications)Page 1 of 6