REGISTRATION FORM
Date: 2026-07-01 Reg. No.: 2026/896 Center Code: 2026 Name : Piyush Mourya Father s Name : Chob Singh Date Of Birth : 2007-05-29 Contact Address (Correspondence) : Bujhiya Janubi, Bhojipura, Bareilly Uttar Pradesh Pin :- 243202 Contact Address (Permanent) : Bujhiya Janubi, Bhojipura, Bareilly Uttar Pradesh Pin :- 243202 Contact Details : (R) (O) (M)  Name Of Course : Certificate Course In Electronics Software Covered :  Course Fee : 1100 Rs GST : 0 Rs Total Fee : 1100 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)