Course you wish to apply for:

PERSONAL INFORMATION

(Exactly as appears in certificate of last qualifying examination)

Name of the Student:

Father's Name:

Mother's Name:

Date of Birth: DD/MM/YYYY:

Gender: M / F:

Last Academic Qualification:

Year of Passing:

Contact Details: Residential Phone Number:

Mobile Number:

Email ID:

Full Address for Correspondence:

Centre you wish to Join: Branch Name:

City Name:

How did you first hear about PANNACHE:

PARENT'S & SPOUSE INFORMATION

Father's / Guardian Name:

Phone Number:

Address:

Occupation:

Email id

Do your Parents / Spouse support and encourage your interest in this field?

To complete your online registration you need to make an online payment of Rs 5,000 as registration Fee.

Account Holder : Pannache Academy
Account No : 123605001712
IFSC : ICIC0001236
BANK : ICIC BANK
Branch : Jogeshwari east

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