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Application Form | ||||
| Name of Candidate | Santosh Kumar Das |
911041520077 
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| Mother's Name | Rekha Devi | |||
| Father's Name | Kailash Kumar Das | |||
| Date of Birth * | 12-Mar-1996 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | At - Mojahidpur, PO - Parbatta, PS- Parbatta, Dist. - Khagaria, Bihar 851216 | |||
| Mobile No. | 8603542616 | |||
| Email Address | imsantoshbgp@gmail.com | |||
Course Details |
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| Course Name /Code | Advance Diploma in Computer Application (ADCA) | |||
| Course Duration | 12 Months | |||
Center Details |
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| Center Code | 91104152 | |||
| Center Name | Evergreen Computer Training Institute | |||
| Center Address | Nathnagar | |||
| Decleration I hereby declared that all the informations are correct and true to the best of my knowledge and belief. |
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Place: _______________ Date : _______________ |
Authorized Signatory |
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