Wizard Tech Computer Academy Pvt. ltd.

Lah Bazar Salempur, Chapra, Bihar 841301
9572095268 | info@wtca.co.in | https://lms.wtca.co.in/

Application Form

Name of Candidate

Student Photo Not Available
Mother's Name
Father's Name
Date of Birth * 01-Jan-1970
Gender
Nationality INDIAN
Present Address
Mobile No.
Email Address

Course Details

Course Name /Code ()
Course Duration

Center Details

Center Code
Center Name
Center Address
Decleration

I hereby declared that all the informations are correct and true to the best of my knowledge and belief.

Place: _______________

Date : _______________
Authorized Signatory