AGARWAL STUDY CENTRE
REGISTRATION FORM H.O. - 11 – A, Vikramaditya Puri, SBI
ASC
v
Colony, Surkha Bankhana, Bareilly. Br. - Opp. Dr. S. K. Agarwal, Thana Road, Prem Nagar, Bareilly. Br. - 35-H/1-A, Rampur Garden, Bareilly. Ph. 09837241100 E– mail: agarwalstudycentre1991@gmail.com
( A Collective of Professionals )
Reg. No.
S. No. ………………
Name of Candidate
: ____________________________________________________
Father’s Name
: _____________________________________
Father’s Occupation
: _____________________________________
Date of Birth
: _____________________________________
Permanent Address
: _____________________________________
Affix Recent Colour Photo
____________________________________Phone___________________ Correspondence Address: _____________________________________ ____________________________________Phone___________________ Details of Qualifications: S.
Exam
No. 1 2
Year of Passing
3
HIGHSCHOOL INTERMEDIATE GRADUATION
4
CPT
COLLEGE/BOARD
MARKS
MAXIMUM
OBTAINED
MARKS
Note: Enclose the photocopy of the marksheets.
Signature of Father/ Guardian
FEE Details
Due Date
Signature of Candidate
Amount
Date of Payment
Signature
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