Indira Gandhi National Institute of Computer

APPLICATION FORM FOR AFFILATION

State*

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City*

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.

Phone 1 *

Phone 2

Email ID *

Information About Centre Head :

Name of the Head *

Position Hold Centre *

P.O *

Address of the Centre Head*

Pin*

P.S *

Phone(Optional)

Email of the Centre Head*

Date of Birth *

Nationality *

Religion *

Gender*

Available Infrastructure Facility of the Centre :

DOCUMENTS :

Color Passport Size Photo Of The Centre Head

Voter Card/Aadhar Card Of The Institute Head

Pan Card Of The Institute Head

Trade License Of The Institute

Color Photo Of Office Room

Color Photo Of Practical Room

Color Photo Of Theory Room

DECLARATION

I hereby certify that the context stated above are correct and true to my knowledge and belief and hereby confirm that our Organization / Society / Trust is free from any legal / official disputes whatsover.I accept that any facts stated above. I found incorrect will automatically result in cancellation for nominations associate.However I will have no right whatsover to fight / challenge legally against the judgment in any court of law.

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