PDIMT INTERNATIONAL FIRE & INDUSTRIAL SAFETY ENGG.

(AN ISO 9001-2015 Certified Institution)

Original Certificate Receiving Format

SESSION: 2020-2021

(FILL IN CAPITAL LETTERS)

COURSE NAME: PG DIPLOMA IN INTERNATIONAL FIRE AND INDUSTRIAL SAFELY

ENGINEERING

1. Student Name (in Block Letters) : _________ANIL KUMAR

PRADHAN_______________________________________________

2. Father’s Name:____________________NILAKANTHA

PRADHAN___________________________________________________

3. Student Certificate Number:_______P0208603___________ Date of

Received:_________12.07.2021_________________

4. Contact No :-________8458074239________________________ E-mail

:-______pradhananilkumar44@gmail.com___________________________

5. Date of the

Training:_______26.04.2020__________________to_____________25.04.2021____________________

_____

6. Address:

Permanent address Present Address

AT:- Khamarsahi AT:- Khamarsahi
PO:-khamarsahi PO:-khamarsahi
PS:Daspalla PS:Daspalla
DIST:-Nayagarh DIST:-nayagarh
STATE:-Odisha STATE:-Odisha
COUNTRY:-India COUNTRY:-India
PIN:-752091 PIN:-752091

Declaration by the Student.

 I declare that, I received my original certificate from PDIMT International Fire and
Industrial Safety Engineering and the details are mentioned in original certificate found
correct by me.

PLACE_______BHUBANESWAR___________ ANIL KUMAR PRADHAN

DATE: _____12.07.2021_____________ Signature of the

Student