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As Per S.S.C) FATHER S NAME (In Block Letters As Per S.S.C) MOTHER S NAME ( In Block Letters as per any Id Proof issued by GOVT.,) Degree Branch COURSE AND BRANCH MONTH & YEAR OF PASSING EXAM (To be filled by the candidate, who completed the course) PERMANENT ADDRESS PIN CODE: MOBILE NUMBER FEE TO BE PAID : (Rs.200/-) Bank: D.D./Challan No Date: NOTE: 1. Demand Draft / Challan for Rs. 200/- should be drawn in favour of the REGISTR.

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