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Application Form | ||||
| Name of Candidate | Jackson Marak |
911031880002 
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| Mother's Name | Bojonti Sangma | |||
| Father's Name | Sundarsing Marak | |||
| Date of Birth * | 02-Dec-1992 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | Nakhuti Garo Basti, P.O+P.S - Chungajam District - Golaghat State - Assam | |||
| Mobile No. | 9395496433 | |||
| Email Address | jetrajackson@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 | 91103188 | |||
| Center Name | Computer Training Institute | |||
| Center Address | Manpur | |||
| 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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