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APPLICATION FORM FOR AFFILATION

STATE
DISTRICT
City / Town / Village

INSTITUTE INFORMATION

Name of the Institute
Year of Establishment
Status of The Institution
P.O.
P.S.
Pin
Postal Address of the Institute

INSTITUTE CONTACT NO.

Phone1
Phone2
Email ID

INFORMATION ABOUT CENTRE HEAD

Name of the Centre Head
Position Hold of the Centre
P.O
Address of the Centre Head
Pin
P.S
Mobile
Email of the Centre Head
Date of Birth of the Centre Head
Nationality
Religion
Gender

DOCUMENTS :

Color Passport Size Photo Of The Centre Head
Photo must be in .jpg/.jpeg/.bmp And Siz less than 500KB
Voter Card Of The Institute Head
Photo must be in .jpg/.jpeg/.bmp And Siz less than 500KB
Pan Card Of The Institute Head
Photo must be in .jpg/.jpeg/.bmp And Siz less than 500KB
Payment Receipt
Photo must be in .jpg/.jpeg/.bmp And Siz less than 500KB
Color Photo Of Office Room
Photo must be in .jpg/.jpeg/.bmp And Siz less than 500KB
Color Photo Of Practical Room
Photo must be in .jpg/.jpeg/.bmp And Siz less than 500KB
Color Photo Of Theory Room
Photo must be in .jpg/.jpeg/.bmp And Siz less than 500KB
DECLARATION BY CENTER HEAD

I hereby declare that all the above statements are true and correct the best of my knowledge and belief. I shall obey all the Rules and Regulations of the organization.