Institution Affiliation Application Form

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1. Registration Details / पंजीयन का विवरण * अनिवार्य फिल्डस (Mandatory fields)
Name of the Institution *
Post Address of the Institution *
Country *
District ,State/U.T. where situated *
Pincode *
2. Institution Head:
Name *
Telephone (Office)
Mobile *
Fax No.
E. Mail. *
Adhar No.
3.Contact Person:
Contact Person: (name) *
Telephone (Office)
Mobile *
E. Mail. *
Adhar No.
4. Institution Details
Nature of Institution *
Registration Number (if any)
Date, Month & Year of Registration
Whether All our country Organization * Yes No
Does the organization have any previous experience in Any work? * Yes No
If yes, was any grant sanctioned from Government or other Organization? *
Whether the office of the organization is located in own building or rented building? * Yes No
Brief History of the Agency, list objective and activities.(200 Words)
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Certified that information furnished is correct to the best of my knowledge.