Registration Form: Computer Institute

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123, Platinum Mall

COMPUTER Baghpat Road, Near


INSTITUTE Malyana Flyover Meerut
Knowledge Is Power Website:- pixelcomputer.in
Ministry of Corporate Affairs (Govt. of India) Reg. No.: UP56 D00 21995 Contact:- 9456968800
9258618648
S.No. _______ REGISTRATION FORM
Personal Details:-
Student’s Name:
Father Name:
Mother Name: Passport Size Photograph

Address:

State: Pincode

Religion: Hindu Muslim Christian Sikh Other Religion:


Sex: Male Female Category: General OBC SC ST
Nationality: Mobile No.
Alternate Mobile No.
C e r t i f i c a t e N o :

Email ID:
Qualication: Date Of Birth:
DD/MM/YYYY

Course: C e r t i f i c a t e N o :

Batch Time:
How did you come to know about Pixel Computer Institute?
Promotions Team Newspaper Teachers Ex-Students Website Friends/Relatives
C e r t i f i c a t e N o :

Place:
Date: Signature:
C e r t i f i c a t e N o :

(For Ofce Use Only)


Registration No.: Fee Concession
I Installment
Enrollment No.: II Installment
III Installment
Course Duration: IV Installment
Revision Batch: Yes/No Authorised
Signature

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