REG. NO :

choice foundation

REGD. NO. : 190300620 IN TR ACT 1882, GOVT. OF INDIA

Benachity, Durgapur - 713213, Paschim Bardhaman

Mob. : 6295584343 / 8972263758

Email : choicefoundationdgp@gmail.com

area / block / district franchise

name of the org :

scheduled date of commencement : (dd/mm/yyyy)

name of applicant (in block letters)

name of guardian (in block letters)

age :

date of birth (dd/mm/yyyy) :

Contact No. :

whether belong to : sc st obc gen

educational qualification : sslc pdc/+2 degree diploma pg

(Attested Copies of SSLC and Other Qualifying Certificates to be Attached)

permanent address :

nature of business :

document attached as proof of :-

COPY OF - (A) Passport, (B) Adhaar Card, (C) Voter Card, (D) Photography Attested by a Gazetted Officer

adhaar no. :

Place :

Date :