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Nomination form

Uttarakhand INSTITUTE OF RURAL DEVELOPMENT
RUDRAPUR, UDHAM SINGH NAGAR

REGISTRATION/NOMINATION FORM

Name Of Course : ....................................................................... Duration (Date):
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Details of the Participant
Name : ....................................................................................................................................
Father's Name : ......................................................................................................................
Sex : ........................ (M/F) Marital Status : ............................................
Date of Birth (mm/dd/yy): .................................................................... Category : ........................ (GEN,SC,ST,OBC)
Designation : .................................................................... Department : ...............................................
Permanent Addess : Postal Address :
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Ph. No. ( including STD code) :

Res. ............................................................
Off. ..............................................................

Mob. ............................................................
Email Address : ....................................................................................................
Educational Qualification (Indicate Highest Degree): .............................................................

Area ........................... Name of Institute : .............................................................................
Name of Previous Service (If any) : .........................................................................................
Total working experience (in yrs): ..........................................................................................
Hostel Room No.: ...............................(For Official Use)
Date of reporting in Institute : ..........................................(For Official Use)
 



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Participant Signature

 

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