NIELIT CCC EXAM FORM – DIVINE COMPUTER CENTER, SIAHA

Full Name *Same with Aadhaar Card

Father's Name *

Mother's Name *

Category *

Gender *

Date of Birth *

Same as Aadhaar

Occupation *

Whatsapp Number *

Mobile Number *0 / 10

Email Address *Mahni email hmanlai ngei hman tur

House No. *

Landmark *Eg: Near YMA Hall

Village *khua/veng hming

District *

ZIP / PIN Code

Highest Qualification *

Date of Passing

Adhaar Card Photo *

No file chosen

Front Side

Adhaar Card Photo *

No file chosen

Back Side

Passport Photo *

No file chosen

Color fiah tha tak, tharlam ber -JPEG only (Max. size 2-mb)

Signature Photo *

No file chosen

Paper var ah Pentui hmawr lian deuh in fiahtaka sign a, thla lak tur

Left thumb impression Photo *

No file chosen

Pentui pawl a kutzungpui ziah pawl hnuah Paper var ah nem kai a, thla lak tur

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