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Course Name       Password
Candidate Name   Father Name
Mother Name   Date of Birth
dd-mm-yyyy
Address   City
State   Pin Code  
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Please provide active email address
to receive login details.		   Upload Photo  
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dd-mm-yyyy
Ch/Dd/Trans Number     Bank Name  
Your Account No     Deposit Amount
 

I declare that the information given above is true and complete to the best of my knowledge & belief.

 
 

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