AKHIL BHARTYA CHHAT MAIYA SANSTHAN

Select Your Course Name* Select Course Name Journalism in English COM(Computer Office Management) CCC(Computer Concept Certificate) ADCA Computer Diploma in computer Application & Networking Diploma In Office Accounting & publishing (DOAP) Diploma In Computer Application (DCA) Diploma In Computer Application Web Technology (DCAWT) Diploma In Computer Programming (DCP) Diploma in Computer Hardware (DCH) Diploma in Computer Networking (DCN) Diploma in Hardware & Networking (DHN) Diploma in Computerized Financial Accounting (DCFA) Basic Computer and Advance Excel Advance Diploma in hardware networking Advance Diploma in Web desining Advance Diploma in Office Management Advance Diploma in computer Programing Advance Diploma in computer Application & Net. Sewing (Tailoring) Tailring & Cutting Beauty Parlour Personality Development Sales Marketing Competition Schooling Academic Tourism

Course Duration* Select Duration 3 Months 6 Months 12 Months 2 Years 3 Years

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Candidate's Last Name

Father's Name/Husband Name *

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Gender * Select Gender Male Female Others

Religion * Select Religion Hindu Muslim Sikh Christion Bodh Jain

Date of Birth *

age *

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Maritial Status * Select Maritial Status Single Married Devorce Widow

Mobile No.*

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Document Type* Select Document Adhar Voter Id Driving Licence Passport Others(Mention Number)

Document Number*

Email Id

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Locality*

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Mobile Number*

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Permanent Adress(If Same Please Check)

Same as present address.

House No./Street*

Locality*

State*

City*

District*

Pincode*

Mobile Number*

Phone Number

Eduactinol Qulification

SN.	Qulifiction	Name Of the Degree	Passing Year	University/Board	Institute/College Name	Total Marks	Obtain marks	% Of Marks
1.	10th
2.	12th
3.	Graduation
4.	Post Graduation
5.	Any Other Courcess

1.Write % of Marks with the two digit after the decimal. The digit of the decimal should be rounded off .e.g. if marks is 60%, then write 60.00%.if Marks are 68.938 % Then Write 68.00% 2.if Case your university/institute does not award marks, please Convert grade (CGPA) to percentage marks and fill.

Other Details

Experience if any The Experience Should be Cerified in Any filed if you filled. Select Experiance Yes No

Skill Talent Select Skill Talent Acting Art & Craft Dancing Debating Drawing Fashion Singing Photography Playing Guitar Painting Others

Sports Select Your Sports Badminton Basket Ball Chess Cricket Tenis Table Tenis Valley Ball Orhers

Upload Photo Photo Should Be 20 Kb to 50 Kb and .jpg format *

Upload Signature Signature Should 20 kb to 50 Kb and .jpg format *

• 1. Documents Should be verify by the institute physically
• 2. All Documents documents Should be attested by you.
• 3. After Submission of Application Copy off documents will be submit to the intitute

DECLARATION

Read Form carefully before Submission.

I hereby declare that all the information given in the aforementioned format is true to the best of the my knowledge. I undertake an accpet that if any of the information given by me is found to be incorrect , then my application will be rejected andf if appointmented will be terminated and action may be taken accordingly.