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Application Form | ||||
| Name of Candidate | Jiya Srivastava |
911041030231 
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| Mother's Name | Kumkum Srivastava | |||
| Father's Name | Vijay Kumar Srivastava | |||
| Date of Birth * | 16-Jul-2005 | |||
| Gender | FEMALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | AT-CHHOTI HAT SABOUR PO+PS-SABOUR, DIST-BHAGALPUR, 813210 | |||
| Mobile No. | 9931446038 | |||
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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 | 91104103 | |||
| Center Name | Sterliate Training Institute | |||
| Center Address | Sabour | |||
| 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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