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Application Form | ||||
| Name of Candidate | Sonali |
911029041121 
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| Mother's Name | Rupa Devi | |||
| Father's Name | Vijay Kumar Tanti | |||
| Date of Birth * | 05-Feb-2009 | |||
| Gender | FEMALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | Ward no10,kirani tola khuthari,lalapur bhader,kahalgaon, bhagalpur, bihar pin-913203 | |||
| Mobile No. | 9955223117 | |||
| Email Address | punajsmith@gmail.com | |||
Course Details |
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| Course Name /Code | Certificate In Computer Application (CCA) | |||
| Course Duration | 3 Months | |||
Center Details |
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| Center Code | 91102904 | |||
| Center Name | Computer Training Institute | |||
| Center Address | Kahalgaon | |||
| 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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