Revision: 7.

DOEACC SOCIETY [For Official Use only]

[An autonomous scientific body under Department of IT, Ministry of Communications and IT, Govt. of India]
Reg No______________
FORM FOR REGISTRATION: STREAM – O/A/B/C LEVEL
[NOTE : PLEASE TICK ‘√’ WHICHEVER IS APPLICABLE. WRITE IN CAPITAL LETTERS ONLY. LEAVE ONE BLANK BETWEEN WORDS.] Lot No __________

1. REGISTRATION SOUGHT FOR O/A/B/C (O/A/B/C) LEVEL EXAMINATION

2. WHETHER ALREADY REGISTERED WITH DOEACC, IF YES , LEVEL O/A/B/C

3. NAME

Photograph
3.5x3.5cms.
Attested by a
4. FATHER’S NAME Gazetted
Officer / Panchayat /
Bank Officer
On Front Side only

5. MOTHER’S NAME

…….…………………………………
Signature of the candidate
6. CORRESPONDENCE ADDRESS

CITY
STATE PIN

7. PERMANENT ADDRESS

CITY
STATE PIN

8. PHONE NO. STD 9. MOBILE

10. EMAIL ADDRESS

11. DATE OF BIRTH (In Christian Era, DD/MM/YYYY format) D D M M Y Y Y Y 12. CATEGORY SC ST OBC GEN

13. SEX MALE FEMALE 14. MARITAL STATUS SINGLE MARRIED WIDOW WIDOWER DIVORCEE

15. HANDICAPPED YES NO 16. EX-SERVICEMAN YES NO 17. RELIGION CODE

18. WHETHER UNDERGOING COMPUTER COURSE ACCREDITED UNDER DOEACC YES NO

If YES: ACCREDITATION NUMBER of the Institute A C C R -

If NO, Experience in Years

19. DOEACC QUALIFICATIONS (If Any, Highest only): LEVEL O/A/B/C & REGISTRATION NUMBER Year of Passing YYYY

20. HIGHEST EDUCATIONAL Qualification Code , If Others Specify ____________________________ Year of Passing YYYY
21. PAYMENT DETAILS (onetime non-refundable processing fees):
Mode of Payment (Please Tick ‘√’) DEMAND DRAFT CREDIT CARD DEBIT CARD ICICI BANK CHALLAN
Draft No/ Transaction ID/ Challan No
Name of the Issuing Bank
Amount (in Rupees) Date D D M M Y Y Validity (in Months)

Certified that, the information furnished above are true to the best of my knowledge and belief.
Date:
Place: [Signature of the Applicant]
 INSTRUCTIONS TO THE APPLICANT
To fill-up the Registration Application Form:
Point- 1: To which level the candidate wish to register, at any point of time registration can be done for only one level.
Point- 2: If registered please mention the Level and Registration Number.
Point- 3: Name as per the Educational Certificate (HSC/10th/Matriculation or equivalent), Please note that the final certificate to be
awarded in the name written in the registration application form.
Point- 4 & 5: Father‟s / Mother‟s name should be as per the educational certificate.
Point- 6 & 7: Valid communication address, Please do not repeat name.
Point- 8 & 9: Valid and functional phone numbers only.
Point- 12 & 13 & 14 & 15 & 16: Please Tick (√) whichever applicable.
Point- 10: Only operational e-Mail ID.
Point- 11: As per the HSC/10th/Matriculation or equivalent certificate.
Point- 17: Please refer the Religion codes given below.
Point- 18: If undergoing training from accredited institute, please mention the correct ACCR-NO and name of the institute and forward
the form through the institute under their seal and signature.
Point- 19: If qualified in any DOEACC course, please mention the Level, Registration No and year of passing.
Point- 20: Please refer the Educational code given below.
Point- 21: Fill every column appropriately with respect to the payment details.

General:
 The Demand draft should be drawn in favour of “DOEACC Society”, payable at “New Delhi” which should preferably have six months
validity period. Do not forget to write your name, Level applied for & address on the reverse of the draft.
 Attach attested photocopies of certificates of educational qualifications and experience certificate.
 Paste a recent photograph of 3.5x3.5cms attested on front side by a Gazetted Officer/ Panchayat/ Bank Officer.
 Candidates undergoing „A‟ Level accredited course concurrently with graduation or Govt. recognized Polytechnic Engineering Diploma
after 10+2 should send proof of the same from the respective institute/college.
 Proof of equivalence in terms of Indian Universities should be sent in case registration is sought based on foreign qualifications.
 Candidates denied registration should not refer to any document sent with the earlier registration form, while seeking registration again,
a fresh registration form, which should be complete in all respects, including all relevant enclosures should be sent.
 Registration forms, received after the last date, for a particular examination will not be considered for that examination. It will be
processed for the immediate next examinations.
 Any query related to registration can be send to: regn@doeacc.edu.in

Educational Codes:
01 10+ITI recognized 02 10+Govt recognized Polytechnic Engineering Diploma
03 10+2 04 10+2+Govt. recognized Polytechnic Engineering Diploma
05 Undergoing Govt. recgd Pol Engg Diploma after 10+2 06 Undergoing graduation after 10+2
07 Govt. recognized PPDCA 08 Govt. recognized PGDCA
09 Graduate 10 Post Graduate
11 Doctorate (Computer) 12 GATE (Computer)
13 NCVT – DP & CS /COPA 14 DOEACC „O‟ Level qualified
15 DOEACC „A‟ Level qualified 16 DOEACC „B‟ Level qualified
17 Others (Candidate has to specify the course name)

Religion Codes:
C Christianism H Hinduism
I Islamism S Sikhism
O Others (Candidate has to specify the name of his religion)

Candidate must ensure that the application is completely filled-up and submitted with appropriate
enclosures as per the checks given below:
Only one letter has been written in one box Yes | No
The Registration application form has been filled in with a ball point pen and in capital letters only Yes | No
The attested photograph is firmly affixed (pasted not stapled) at the appropriate place. Yes | No
The name written as per the Educational Certificate ((HSC/10th/Matriculation or equivalent) Yes | No
Only the highest qualifying educational certificate/mark sheet / Provisional Certificate are attached herewith Yes | No
The photograph affixed (not stapled), is latest and in good condition Yes | No
The registration fee amount paid is of exact amount and not clubbed with any other fees Yes | No
The Registration level applied for and the eligibility criteria required for the Level, is satisfied Yes | No
The demand draft is fresh and valid for at least six month Yes | No
The attested copies of Educational Certificates are firmly attached Yes | No
Payment receipt/ Challan receipt/ Demand draft is attached properly
For candidates applying for registration through an accredited institute:
That the Registration Application form is forwarded through the Institute with a valid Accreditation Number Yes | No
For candidates applying for registration as a direct candidate:
The experience certificate duly certified by my employer is attached Yes | No

Filled-in Registration Application Form should be sent to:

Registration Section
DOEACC Society
Electronics Niketan
6 CGO Complex
New Delhi-110003

Phone: (011) 24363330/01/02, 24366577/79/80, Fax: 24363335, Web-site: www.doeacc.edu.in, Email: doeacc@doeacc.edu.in