7/8/2017

Application form for admission in B.Ed. Course(2017-2019)

College #1 L.N. MISHRA COLLEGE OF BUSINESS MANAGEMENT

College #2 Chandrasheel College of Education
College #3 L.P. SHAHI INSTITUTE OF TEACHERS EDUCATION
College #4 DR. JAGANNATH MISHRA MAHAVIDYALAYA
College #5 Dashrath Prasad Singh Institute of Teacher Education
Application Form No. 1703287

Personal Details

Name of Student Puja

Father/Husband name Ramumed Shukla
Mother name Chitrarekha Devi
Date of Birth 15-02-1994
Gender Female
Category General
Mobile No. 7008685787
Marital Status Married
Physically Challenged(PH) No
Email id pujashukla254@gmail.com
Permanent Address
Rahul Nagar, Po- MIT PS- Brahampura Near Suji Mill Dist- Muzaffarpur Pin- 842003
Present/Correspondence Address
Rahul Nagar, Po- MIT PS- Brahampura Near Suji Mill Dist- Muzaffarpur Pin- 842003

Graduation Details

Name of College L S College

Board/University BRABU
Year of Passing NA
Percentage of aggregate marks (not
NA
only in honours paper)

Payment Details

Payment Status Your payment has been received.

I declare that all the details given above are true, complete and correct to the best of my knowledge and belief. In the event
of any information being found false or incorrect my candidature would stand cancelled without any further notice.

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