Kushal Yuva Program/SHA Registration Form

BSDM’s SDC Techizer EduTech pvt.ltd, Indradev chowk,Jiratitola Road, Sahebganj,Muz, Mob-9973680071,7324801151

Candidate Name :- ………………………………………………………………………………………………………………………………………………………

Father’s Name :-……………………………………………………………………………………………………………………………………………………….

Mother’s Name :-………………………………………………………………………………………………………………………………….........................

Date of Birth : ……………….................... Gender: ………………………Aadhar number : ……………………………………………………....

Address Details :-

Vill :………………………………………………….., PO : ………………………………………. Panchayat :……………………………………………....…..

PS : ………………………………………………….. Dist : ………………………………………Pincode : ……………………… Category………………..

Bank Details :-

Bank Name :………………………………………, Branch Name : ………………………………………………………………………………………………

Account Number : ………………………………………………………………………………, IFSC Code : ………………………………………………….

Mob : …………………………………………………email id : ……………………………………………………………………………………………………….

Qualification School Name Board Name Roll No Roll Code Passing year
Matric(10 th)
12 th
Registered by………………………………………………Registration Date: …......................................DRCC Date :……………………….

...................................................................X......................................................................X.............................................................

Kushal Yuva Program/SHA Registration Form

BSDM’s SDC Techizer EduTech pvt.ltd, Indradev chowk,Jiratitola Road, Sahebganj,Muz, Mob-9973680071,7324801151

Candidate Name :- ……………………………………………………………………………………………………………………………………………..…..

Father’s Name :-…………………………………………………………………………………………………………………………………………………...

Mother’s Name :-…………………………………………………………………………………………………………………………………………………….

Date of Birth : ……………….................... Gender: ………………………Aadhar number : …………………………………………………..

Address Details :-

Vill :………………………………………………….., PO : ………………………………………. Panchayat :…………………………………………..…..

PS : ………………………………………………….. Dist : ………………………………………Pincode : ……………………… Category……………

Bank Details :-

Bank Name :………………………………………, Branch Name : ………………………………………………………………………………………...…

Account Number : ………………………………………………………………………………, IFSC Code : ……………………………………………….

Mob : …………………………………………………email id : …………………………………………………………………………………………………….

Qualification School Name Board Name Roll No Roll Code Passing year
Matric(10 th)
12 th
Registered by………………………………………………Registration Date: …......................................DRCC Date :……………………….