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Application Form | ||||
| Name of Candidate | Sameer Ansari |
911052220343 
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| Mother's Name | Mahjabeen Parveen | |||
| Father's Name | Azhar Hussain Ansari | |||
| Date of Birth * | 11-Jan-2000 | |||
| Gender | MALE | |||
| Enrollment No. | ||||
| Nationality | INDIAN | |||
| Present Address | S/O Azhar Hussain Ansari, ward no. 14, Khodanagar, Motihari East Champaran Bihar 845401 | |||
| Mobile No. | 9113426937 | |||
| Email Address | Vk08257600668@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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