REGISTRATION FORM
Date: 2024-01-12 Reg. No.: 2026/460 Center Code: 2026 Name : Samudra Gautam Father s Name : Dal Chandra Gautam Date Of Birth : 2000-06-12 Contact Address (Correspondence) : Distt. Budaun vill. khajuriya Contact Address (Permanent) : Distt. Budaun vill. khajuriya Contact Details : (R) (O) (M)  Name Of Course : Diploma Program Software Covered :  Course Fee : 10500 Rs GST : 0 Rs Total Fee : 10500 Rs I have read the terms & conditions printed overleaf, Understood the same and here by confirm having accepted the same for joining the course For : MORADABAD UTTAR PRADESH         Student s Signature Authorised Center (Seal & Signature)