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Application Form | ||||
| Name of Candidate | Md Shahzad Azam |
911041390013 
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| Mother's Name | Bibi Sogara Khatoon | |||
| Father's Name | Md Wali Uddin | |||
| Date of Birth * | 12-Mar-1976 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | bhikhanpur ,tank lane gumti no.3,bhagalpur-812001 | |||
| Mobile No. | 9934706328 | |||
| Email Address | shahzad.azam1976@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 | 91104139 | |||
| Center Name | Lord Buddha Computer Training Centre | |||
| Center Address | Adampur | |||
| 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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