A division of Icon Computer of Education Regd. Under Companies Act | Ministry of Corporates Affairs Govt of India Regd Office : Rajeev Nagar Road No. 24 Patna 800024 |
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Student Details |
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| Name of Candidate | : |
Reg. No. 
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| Mother's Name | : | |||
| Father's Name | : | |||
| Date of Birth * | : | 01-Jan-1970 | ||
| Gender | : | |||
| Nationality | : | INDIAN | ||
| Present Address | : | |||
| Mobile No. | : | |||
| Email Address | : | |||
Course Details |
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| Course Name /Code | : | () | ||
| Course Duration | : | |||
Attached Document |
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| Identity Proof | : | Sorry No Attachment | ||
| Educational Certificate | : | Sorry No Attachment | ||
| 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 : 01-Jan-1970 |
Signature of Student |
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Center Details |
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| Center Code | : |
Verified By |
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| Center Name | : | |||
| Center Address | : | , () | ||
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Educational Proof