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App Form Chen

The document is an application form for a technical services course. It requests information such as name, address, date of birth, category, qualifications, experience, registration fee details, and signature of the applicant.

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arunscribd20
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16 views

App Form Chen

The document is an application form for a technical services course. It requests information such as name, address, date of birth, category, qualifications, experience, registration fee details, and signature of the applicant.

Uploaded by

arunscribd20
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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NSIC TECHNICAL SERVICES CENTRE

CHENNAI 600 032


THE COURSE APPLIED FOR
1 Name. 2 Father's Name/ Guardian's Name 3 Date of birth & age 4 Address for Communication : : : : D : D M M Y Y Y Y yrs

Pin Phone No. 5 Email ID 6 Address - permanent :

Pin Phone No. 7 Whether Hostel facility required 8 Category 9 Educational Qualification(s) : : : Yes No (Tick the option)

SC/ST/OBC/MIN/PH/GEN/Ex.Ser Pl.specify: a. b. c.

10 Experience if any

11 Registration Fee Details

Rs. Bank :

250/Date : / /

DD No.:

12 Signature

Date :

FOR OFFICE USE ONLY


Admitted for the Course Total Fee to be paid Fees paid at the time of admission Caution Money Deposit : : : : Yes Rs. Rs. Rs. Date: Date: / / / / No

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