Examination Details / परीक्षा विवरण

Applied As / किसके रूप में आवेदन किया *

Direct / सीधाInstitute / संस्थान

Applied for Examination / किस परीक्षा के लिए आवेदन किया*

--------Select Course Category-------- Competitive Course Computer Course Nielit/DOEACC Course Professional Course Subjective Course University Course

-------Select Course Name------ ADCA Advance Diploma in Computer Application (ADCA) Advance Diploma in Financial Tally Accounting Application & Internet Networking(NET) Beautician Certificate in Computer Application Certificate in Desktop Publication (DTP) Certificate in English Speaking Certificate in Hindi & English Typing Certificate in Tally Accounting Certificate on Personality Development Course on Computer Concepts Diploma in Computer Application (DCA) Diploma in Computer Teacher Training (CTT) Diploma in Tally Accounting Diploma in Web Design Diploma in Yoga Teacher English Typing Hindi & English Typing 'O' Level (Ordinary Level) Sewing & Embroidery

Applicant's Personal Details /आवेदक का व्यक्तिगत विवरण

Applicant's Full Name / आवेदक का पूरा नाम *	Mr./श्री Ms./ सुश्री
Father's Name / पिता का नाम *	Mr./श्री
Mother's Name / माता का नाम *	Mrs./श्रीमती

Gender / लिंग*

Select One Male Female

Date of Birth / जन्म दिनांक *
Category / वर्ग*	Select One General/सामान्य Scheduled Caste/अनुसूचित जाति Scheduled Tribe/अनुसूचित जनजाति Other Backward Class/अन्य पिछड़ा वर्ग
Date Of Registration *

Contact Details / संपर्क विवरण

WhatsApp Number *	+91
Mobile / मोबाइल *	+91

Email / ईमेल पता *

Address Details / पता विवरण

Full Address / पता *
City Name / शहर का नाम *
State / राज्य *	-----------Select State--------------- Aasam Andhra Pradesh Arunachal Pradesh Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha (Orissa) Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal
District / जिला *	--------------Select Distt------------- Agra Aligarh Allahabad Ambedkar Nagar Amethi Amroha Auraiya Azamgarh Badaun Bahraich Ballia Balrampur Banda Barabanki Bareilly Basti Bijnor Bulandshahar Chandauli (Varanasi Dehat) CHHATARPUR Chitrakoot Deoria Etah Etawah Faizabad Farrukhabad Fatehpur Firozabad Gautam Buddha Nagar Ghaziabad Ghazipur Gonda Gorakhpur Hamirpur Hapur Hardoi Hathras Jaunpur Jhansi Kannauj Kanpur Dehat Kanpur Nagar Kasganj Kaushambi Kushinagar Lakhimpur Kheri Lalitpur Lucknow Maharajganj Mahoba Mainpuri Mathura Mau Meerut Mirzapur Moradabad Muzaffarnagar Pilibhit Pratapgarh Rae Bareli Raebareli Rampur Saharanpur Sambhal Sant Kabir Nagar Sant Ravidas Nagar Shahjahanpur Shamli Shravasti Siddharthnagar Sitapur Sonbhadra Sultanpur Unnao Varanasi (Kashi)
Pin Code / पिन कोड *

Educational / Qualification Details / शैक्षिक / योग्यता का विवरण

Highest Educational Qualification / उच्चतम शैक्षिक योग्यता *	Select One Other Graduation or Higher Polytechnic Diploma Below 10th 10th Pass 10th + ITI 12th Pass
Year of Passing / उत्तीर्ण वर्ष *

Identification Details / पहचान की सूचना

Aadhar Card Number / आधार कार्ड संख्या*
Upload Photo / फोटो अपलोड *   (Only JPG,JPEG,PNG File Upload)
Upload Signature / हस्ताक्षर अपलोड *   (Only JPG,JPEG,PNG File Upload)
Upload Left Hand Thumb Impression / बांए हाथ के अंगूठे का निशान अपलोड *   (Only JPG,JPEG,PNG File Upload)

Declaration

* I, hereby declare that, I agree to abide by the rules and regulations of Technical Educations and also to the decision of the Registration authority, regarding my eligibility for registration at the desired level. I have noted that the Registration Authority has the right to withhold my Registration application or cancel the allotted Registration No. in addition to any other action as may be deemed fit in the event of any of the statements made above being found incorrect.(मैं एतद्धारा घोषणा करता/ करती हूँ कि मुझे वांछनीय स्तर में पंजीकरण हेतु मेरी योग्यता के संबंध में टेक्निकल एजुकेशन के नियम एवं विनियम तथा पंजीकरण प्राधिकारी का निर्णय भी मान्य है। मुझे सूचित है कि पंजीकरण प्राधिकारी को मेरा पंजीकरण आवेदन रोकने अथवा रद्द करने का अधिकार है। इसके अतिरिक्त उपरोक्त निर्दिष्ट कथन सही न पाए जाने पर किसी भी प्रकार की कार्रवाई करने का अधिकार होगा।)