UNIQUE COMPUTER EDUCATION AND TUTORIAL
AN ISO 9001 - 2015 Certified Institute
STUDENTS REGISTRATION FORM
Student Name
*
First Name
Last Name
Date of Birth
Please select a day
1
2
3
4
5
6
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8
9
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31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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2003
2002
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1962
1961
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1958
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1956
1955
1954
1953
1952
1951
1950
Year
Gender
*
Select Gender
Male
Female
Others
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Mobile Number of Student Or Parents only
Email
example@example.com
Profession
*
Select Your Profession
Student
Government Employee
Private Employee
Self Employed
House Wife
House Hold
Educational/ Qualification
*
Select
1st to 5th
6th
7th
8th
9th
10th
PUC I & II
Any Degree
Diploma/ Engreeing
ITI
Select Course
*
Please Select
Diploma In Basic Computer
Diploma In Web Designing
Diploma In Accounting Package (Tally)
Diploma In Advanced Accounting Package (DAAP)
Diploma In Computer Application
Diploma In Computer Science
Diploma in Computer Hardware & Networking
Post Graduation Diploma In Computer Application
Computer Teacher Training Course
Select Exam Center
Please Select
1] Head Office- Sirsi- Unique Computer Education & Tutorial.
2] Hulekal- Sirsi-
3] Kasturba Nagar- Sirsi-
4] Hangal-opp govt hospital,
5] Dharwad- Nizamuddin Colony,
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Pay Rs 355/- Course Registration and Certificate Charges.
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UTR Number
*
Please Enter 12 Digit UTR Reference Number.
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