AICIT Computer Education please fix I-C

(ISO 90012008 Certified) sized colour

103, Nehru Nagar, Kurla(E), Mumbai-24 photograph.

REGION: ________________DISTRICT: ______________TALUKA______________

APPLICATION FORM
(JENETH MALINAO OMONGOS)

Name:   OMONGOS
 JENETH MALINAO

 First Name  Middle Name  Last Name

Age Male Female
 19  /
Address for Correspondence: Purok-4 San Isidro Bajo, Sinacaban, Misamis Occidental
Date of Birth: NOVEMBER 16, 2000 Nationality: FILIPINO
Tel. Number (for contact, with the person name): 09283334732 ( Anita M. Omongos)
Name of the Parent/ Guardian: ANITA M. OMONGOS
Permanent Address of the Parent / Guardian: __P-4 San Isidro Bajo Sinacaban, Misamis Occidental_
Tel. Number (For contact, with the contact person name): 09283334732 (Jerry C. Omongos)
Previous Educational Qualification: _____________________________________________________
Computer Related Previous Qualification Work Experience (if any): ___________________________
Title of the Course Applied: _______________________________Code: _______________________

Declaration: I hereby declare that the information supplied in this application and the documentation
supporting it is correct and complete to the best of my knowledge. I acknowledge that the provision of
incorrect information or documentation or the withholding of information or documentation relating to may
result in cancellation of any offer or enrollment made based on this application. I further undertake and
guarantee to pay all installment ion time offered as per the norms of AICIT and I am aware that fees paid are
not refundable under any circumstances. I here under sign in affirmation to the above and to the rules and
regulations printed overleaf, which I have read, understood and agreed.

_____________________ __________________________ _______________________

Applicant’s Signature Parent’s / Guardians Signature Date

FOR CENTER USE ONLY

Course Code: _________________________
Authorised Training
Center Total Fees Rs: ________________________
Class Timings: ________________________
Competion Date: ______________________
Date of Admission: ______________
Date of Admission: ______________
Course Material Issued on: ________
Certificate Issuance date: ________

7 perforated