Course Registration Form

Pune Business Education Training Board

Student Admission Registration Form
Student Name :*

PrefixFirst NameMiddle NameLast Name
Father Name :*

PrefixFirst NameMiddle NameLast Name
Mother Name : *

PrefixFirst NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Student E-mail Id :
Mobile Number*

Area CodePhone Number
Phone Number

Area CodePhone Number
Alternate Mo. Number

Area CodePhone Number
Courses*
Other Course Name :
Course Duration Period :*
Month/ Year
Institute Name :
Aadhar card Number :
Document Upload :*

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Photo Upload :*

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Declaration :
I hereby Declare that the information given in this application form is true to the best of me knowledge and belief. If at any sage it is found that i do not satisfy the admission criteria or the information furnished by me in the application form is in correct, I Understand that me admission to the course any how condition may be not cancelled . If Granted admission , I agree to abide my the rules & regulation of the PBETB Board.
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Pune Business Education Training Board