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ASSAM HIGHER SECONDARY EDUCATION COUNCIL

Your Full Name *

Date Of Birth *

Mother's Name *

Father's Name *

Complete Permanent Address * :

State *

District * : Landmark * : PIN Code * :

Tick if same as Permanent Address

Complete Postal Address * :

State *

District * : Landmark *: PIN Code * :

Your Passport Sized Photo *

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Your Signature *

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Valid Email * :

Confirm Email * :

10 Digit Valid Mobile No *:

Password for Login *:

Confirm Password for Login *:

I hereby declare that all information provided by me is correct to best of my knowledge.