APPLICATION FORM FOR AFFILATION

Institute Location:

State:
District:
City/Village:

Institute Information:

Name of Institute:Year of Stablishment:Status of Institute:
P.O.:P.S.:Pincode:
Postal Address of Institute:
Phone1:Phone2:Email Id:


Information about Center Head:

Name of Center Head:Designation/Post:State:
P.O.:P.S.:Pincode:
Postal Address of Institute:District:
Date of Birth:Phone No.:Email Id:
Nationality:Religion:Gender:
Marital Status:Center Head Qualification:Professional Experience of Center Head:
Center Director/Center's PAN No.:Director Aadhar No.:GSTIN No:


Available Infrastructure Facility of Center:

PARTICULARNo. of Rooms
Office Room:
Theory Room:
Practical Room:
Staff Room:
Library:
Reception:
Toilet:
Waiting Room:
Other Room:


Faculty Information of the Center:

Name:Qualification:Teaching Experience:Status Part Time/Full Time:

DECLARATION

I hereby certify that the context stated abouve are correct and true to my knowledge and belief and hereby confirm that over organization/society/trust is free from any legal/official disputes whats ever. I accept that any facts stated above. I found incorrect will automatically result in cancellation for nomination associate. However I will have no right whatsover to fight/challange legally against the judgement in court of law. All disputes are subjected to Ranighat Jurisdiction only.