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Application Form | ||||
| Name of Candidate | Md Mobeen Azam |
911052220242 
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| Mother's Name | Tahira Khatoon | |||
| Father's Name | Shaikh Raisul Azam | |||
| Date of Birth * | 04-Mar-1995 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | S/O Shaikh Raisul Azam, ward.no. 3, Semraiya, East Champaran Bihar 845302 | |||
| Mobile No. | 9631832424 | |||
| Email Address | mobeenazam23@gmail.com | |||
Course Details |
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| Course Name /Code | Certificate In Computer Typing (CT) | |||
| Course Duration | 6 Months | |||
Center Details |
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| Center Code | 91105222 | |||
| Center Name | PDS Computer Education | |||
| Center Address | Motihari | |||
| 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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