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Application Form | ||||
| Name of Candidate | Amit Rana |
911041520137 
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| Mother's Name | Bimla Devi | |||
| Father's Name | Pramod Rajak | |||
| Date of Birth * | 02-Dec-1999 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | Noorpur, madhusudanpur, nathnagar, Bhagalpur, bihar 812004 | |||
| Mobile No. | 9199100328 | |||
| Email Address | 9525Parveen@gmil.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 | 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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