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Apll Enrollment Form

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ENROLLMENT FORM

IT Smart Plus IT Smart Smartizen Degree


Smart Commerce Smartnetizen IT Smart Pro TID
Name …………………………………………………………………………………………………………………………………..
Allix latest
Father’s Name ……………………………………………………………………………………………………………………..
Passport size
Mother’s Name …………………………………………………………………………………………………………………… color
Nationality…………………………………………………………………………………………………………………………… photograph
Date of Birth …………………………………………………………………………………………………(DD/MM/YYYY)
Correspondence address ……………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………............
City ……………………………………………..Pin code………………………………………. State ……………………………………........
Mobile No +91-…………………………………..Landline no …………………………….Email …………………………@……………
Gender: Male Female Blood Group
Occupation………………………………………………………………………………………………………………………………………………..
Languages Known : ENGLISH READ W WRITE SPEAK
HINDI READ WRITE SPEAK
OTHER READ WRITE SPEAK
Education
Examination School/College Board/University Year of passing Percentage
10th /Equivalent
10+2(High school)
Graduation
Post Graduation

Declaration
I here by solemnly declare that the information in the application is true, correct to the best of my knowledge and
belief. The Documentation supporting it will be correct and complete. I have read understood the rules overleaf &
do agree to abide by them.

Place……………….. Candidate Signature…………………….


Date……………………. Parent /Guardian’s name……………………

FOR OFFICE USE ONLY

Receipt No………………………………………………………Centre ………………………………………..City……………………………

Accepted By ………………………………………………………………….. ……… Date ……………………………………………………

Batch No …………………………………………Batch Date ……………………..Center Person Signature…………


With date
& seal

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