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Application Form | ||||
| Name of Candidate | Pankaj Kumar Gupta |
911041020250 
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| Mother's Name | Urmila Devi | |||
| Father's Name | Naresh Prasad Sah | |||
| Date of Birth * | 01-Jan-1992 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | Patel Nagar ward no 17 p.o+ p.s Kahalgaon, dist bhagalpur, state Bihar, pin code 813203 | |||
| Mobile No. | 9801353156 | |||
| Email Address | pankajkumarclg325@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 | 91104102 | |||
| Center Name | Sterliate Training Institute | |||
| Center Address | Khanjarpur | |||
| 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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