info@icaedu.in| https://icaedu.co.in/
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Application Form | ||||
| Name of Candidate | Dhannjay Kumar Pandit |
911004030262 
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| Mother's Name | Sumira Devi | |||
| Father's Name | Rajeshwar Pandit | |||
| Date of Birth * | 05-May-1997 | |||
| Gender | MALE | |||
| Nationality | INDIAN | |||
| Present Address | Birti | |||
| Mobile No. | 9507569055 | |||
| Email Address | PANDITD445@GMAIL.COM | |||
Course Details |
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| Course Name /Code | Diploma In Fire & Industrial Safety Management (DFISM) | |||
| Course Duration | 12 Months | |||
Center Details |
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| Center Code | 91100403 | |||
| Center Name | Hardik Computer Center | |||
| Center Address | Pakwainar Rasulpur | |||
| Date of Admisison | 07-Nov-2021 | |||
| Decleration I hereby declared that all the informations are correct and true to the best of my knowledge and belief. |
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Place: _______________ Date : _______________ |
 Authorized Signatory |
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