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CCC Admission Form

This document is an examination application form for the Certificate Course on Computer Concepts (CCC). It requires personal details, educational qualifications, contact information, and choices for examination centers. The applicant must also declare the accuracy of the information provided and agree to abide by the rules of the examination authority.

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Remrema
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43 views1 page

CCC Admission Form

This document is an examination application form for the Certificate Course on Computer Concepts (CCC). It requires personal details, educational qualifications, contact information, and choices for examination centers. The applicant must also declare the accuracy of the information provided and agree to abide by the rules of the examination authority.

Uploaded by

Remrema
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EXAMINATION APPLICATION FORM - CERTIFICATE COURSE ON COMPUTER CONCEPTS –(CCC)

Signature of the Applicant Left Thumb Impression

Recent Photograph

1. NAME - IN CAPITAL LETTERS

2. FATHER’S NAME – IN CAPITAL LETTERS

3. MOTHER’S NAME – IN CAPITAL LETTERS

D D M M Y Y Y Y
4. DATE OF BIRTH 5. SEX MALE FEMALE
Darken appropriate box
6. HIGHEST QUALIFICATION: (Darken appropriate box AND attach Attested copy of the Certificate, in respect of the Box darkened)
Below 10th 10th Pass 10+2 10th+ITI Polytechnic Diploma Graduation or higher
6.1 Year of Passing 6.2 AADHAAR NUMBER :

7. RESIDENCE DETAILS OF CANDIDATE - IN CAPITAL LETTERS


ADDRESS:

CITY: PIN CODE


STATE:
7.1. CONTACT DETAILS
PHONE NO. EMAIL ID

8. INSTITUTE DETAILS- IN CAPITAL LETTERS 8.1 E-PROV. NUMBER:


NAME:
ADDRESS:

STATUS OF INSTITUTE: ACCR. INSTTT GOVT. RECOG.SCHOOL/COLLEGE OTHERS

9. CENTRE CHOICE First Choice Second Choice


CITY CODE NAME CITY CODE NAME

10. OCCUPATION: (Darken the appropriate box)


Govt. Employed Govt. undertaking Self Employed Other (Please Specify) . . . . . . . . . . . . . . . .
11. CATEGORY: (Darken the appropriate box)
General Scheduled Caste Scheduled Tribe O.B.C.
Handicapped Other Please Specify) . . . . . . . .

12. WHETHER APPEARED PREVIOUSLY IN ‘CCC’ EXAM MONTH YEAR ROLL NO


If YES, give details of immediate LAST EXAM only

13. DECLARATION:

I_________________________________S/o / D/o _________________________________hereby declare that, I


agree to abide by the rules and regulations of NIELIT and also to the decision of the Examination authority, regarding my
eligibility for filling the exam form of BCC/CCC. I declare that the particulars filled in the exam form are true to the best of my
knowledge & belief. I have noted that the Examination Authority has the right to withhold my examination application or result,
in addition to any other action as may be deemed fit in the event of any of the statement(s) made by me in the exam
form/above being found incorrect

Place:

Date: Signature of the Applicant

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