REGISTRATION FORM
Date: 2020-01-01 Reg. No.: 2026/96 Center Code: 2026 Name : Kushik Agarwal Father s Name : Vinay Agarwal Date Of Birth : 2001-05-03 Contact Address (Correspondence) : Devta pg, Shahbadpur Daulatpur, Rohini sector-18, Delhi Contact Address (Permanent) : H.no-38,Lane -B,Rajendra Nagar,Civil Lines,Moradabad Contact Details : (R) (O) (M)  Name Of Course : Certificate Program Software Covered :  Course Fee : 3000 Rs GST : 0 Rs Total Fee : 3000 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)