Certificate Course on Rice Milling Registration Form

A. Personal Information

Full Name: Date of Birth: Gender: --Select-- Male Female Other Father’s / Guardian’s Name: Residential Address: Mobile Number: Email Address: Aadhaar Number:

B. Educational Qualification

10th / SSLC 12th / HSC Graduation Others

C. Professional Background

Are you currently employed? No Yes If yes, Organization Name: Work Experience in Agriculture or Rice Industry (how many years):