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XIPHIAS SOFTWARE TECHNOLOGIES (P).LTD.

APPLICATION/ENQUIRY FORM
Name: PHOTOGRAPH

Address:

City: Pin Code:

E-mail:

Date of Birth: Occupation:

Mobile:

Educational Qualification:

1 Under Graduate
2 Graduate
3 Post Graduate
4 Others (Specify)

Course enrolled:

Dot net: PHP: Mainframe: Embedded: Web development:

Animation: SEO: Java: C/C++: AJAX:

Oracle : CSS: XML: SQL Server: BPO/Call center

I hereby declare that the information provided by me is true. I also declare that I have read the students
terms and conditions; I have understood it and agree to abide by it.

Date:…………………. Place:…………………………. Signature:……………………………….

For Office use only


Receipt No: Roll No:

Date : Enrolled by:

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