National Informatics Centre 
                                Training Division
                               Jayanagar  Chariali
                                     Beltola
                                 Guwahati 781028

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                                 Nomination Form

   Course Code: _____________                    Starting Date: ______________


   Course Title: _____________________________________________________________


   Applicant's Name: _________________________________________________________


   Designation: _____________________________________ Pay Scale: _____________


   Registration No. (if allotted): _________________


   E-mail address: _________________________________


   Name of Organisation/Department: __________________________________________

   Official Address: _________________________________________________________

                     _________________________________________________________

                     Pincode: _____________


   Telephone No.: ________________________


   Computer related experience: Nil / General Exposure / Working Experience
 

   Details of Experience: ____________________________________________________
                       



   Date: _____________________            (Signature of Applicant)


   Certified  that the given particulars are verified and found to be correct.
   The applicant will be relieved only after receipt of acceptance letter from
   National Informatics Centre.




                                    Signature and Seal of Sponsoring Authority
   ___________________________________________________________________________

   For Paid Course only:  Cheque/Draft No.: __________________________________


                          Amount: _____________          Date: _______________