APPLICATION FORM FOR INFORMATION CENTRE

Basic Business Information

1.1 Name/Institution/Agency:

1.2 Postal Address

(With District & Pin Code):

1.3 Registered Address:

1.4 Phone/Fax/E-mail/Telex

(With Appropriate Codes):

1.5Year of Establishment

(In case of institution):

Status of the Institution:

Govt. Institution

(Central/Status U.T):

Private Institution

(Trust/Regs. Societies/Other

to be specified):

1.6Affiliated to/recognized by University/ any

Other Body (specify):

1.7.1 Name of the Affiliating Body:

1.7.2 Postal Address

(With District and Pin code):

1.7.3 Phone/Fax/Telex/E-mail

(With Appropriate Codes):

  1. Computer Facilities

Sl. No. / Computer with Type / No. of
Terminals
Available / Year of
Purchase / Cost / Software
Facilities / Other
Attaching
  1. Infrastructure Facilities.

(Give a layout of the building)

6.1 Facilities available:

Particulars / No. of Rooms / Seating Capacity / Area (s.q.m)

Staff Rooms

Class Rooms
Laboratory
Library
Reception
Rest/Guest Rooms
Toilets
Any Other

(Wherever necessary enclosures may be attached)

3.3 Location of the Institution :

3.3.1 How to reachfrom Kolkata :

3.3.2 Nearest City/Town/Rly Station

(If it is a remote area) :

3.3.3 Nearest Competent Institution/

WORLDRELATION approved Center

(Details to be enclosed):

3.4 Kind of infrastructure facilities avaiable

3.4.1 Rented/Own:

3.4.2 Are all the infrastructure and other

facilities available being used

Exclusively by your Institute/Share :

4.Is there a placement cell in your Institution:

Office Address: All the above information supplied by me is correct.

36/1, Rabindra Path (Gr. Floor)

Po: Birati, Kolkata-700051

Tel :033-25145031/65333750,

9239239008 / 9088854021 / 9088854025 ------

Fax : 033 2514 5031

E-mail: Signature of Applicant

DD No……………………….. Bank Name…………………………………….. Date………………

  • Attach a demand draft (DD) of Rs.1000/- (One Thousand only) in favor of ‘worldrelation.com’ payable at Kolkata for verification charge.
  • If the verification report is not satisfied/cancel by company,theverification chargewill be refund.
  • Last date of receive application form 10-03-2010by courier or register post at office address.

NO: INF/K1220/2010