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Application Form | ||||
| Name of Candidate | Pankaj Kumar |
911041520258 
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| Mother's Name | Kiran Devi | |||
| Father's Name | Krishna Mohan Singh | |||
| Date of Birth * | 01-Jan-1986 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | at - Kolhadda, P.O. - Rupsa, P.S. - Rajoun, Dist - Banka, State - bihar , Pin No - 813105 | |||
| Mobile No. | 8603029951 | |||
| Email Address | pankajkrbanka2020@gmail.com | |||
Course Details |
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| Course Name /Code | Diploma in Computer Application (DCA) | |||
| Course Duration | 6 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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