Request for Empanelment

Complete the Full Empanelment Process

Request an Empanelment of Centre

Please complete the form to for Request for Empanelment of your center. We will reply as soon as possible.

Step 1 of 3

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Applicant Enq Reg No
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Applicant Reg. ID
Name of Applicant*
First Last
Entre Your Gender*
- Male
- Female
DOB Applicant*
DD slash MM slash YYYY
Phone No. of Applicant*
Email of Applicant*
Facebook id of Owner
Other Social ID of Owner
Postal Address of First Owner*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Planning to Start or Running your institute*
Enter your Centre Name (if Proposed also)*
You're Applying as a*
New Startup / Running Centre / RCSM Lock/Incative Centre

Year of Association*

Day
Month
Year
Address of Centre
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Organization Type of Your Institute*
Your Institute/Centre (Rented/Own)*
Total Space of your Centre*
Space of Institute (L*W Size)*
Sl. No. Reception Area Lab Room (Size) Class Room (Size) Wating Hall (Size) Staff Room (Size) Others (Size) Total (Size)
Specify room area size in length x width
Entre Total No.'s of Employee Details*
No.'s Teaching Staff No.'s Non-Teaching Staff Total Staff
Centre Owner also teaches as Faculty/Instructor*
Owner Name Teach (Yes/No) Experience Modules teaches by you (i.e-tally, C, DCA , DTP)

If Centre Manager has interest in teaching please mention
Laptop/Desktop Details in Centre*
Laptop/Desktop Assembled/Company Make/Brand Processor Speed (MHz/GHz) Memory (GB) HDD (GB/TB) Wi-Fi (Yes/No) No.'s
List of Peripherals available in Centre (Printer/Camera/Wifi/Lan etc)*
Sl. No. Peripherals Name Make Description Qty (Present)
Available Internet Connection Speed*

Mention in Mbps/Kbps
Monthly walk in & Conversation ration (%) details of Institute
Sl. No. Total Walk in Enq/month Total Phone in Enq/month Others Total % Of Conversations/month
Courses demand of Institute by student
Sl. No. Course Name Demand (%)

Add up to 7 course and all in total % should be 100% only, Through which it will judged kind of course are in demand .
Last three Financial Year Student Enrolled in Institute
Financial Year Total Business No.'s of Student Total Profit/Loss (+/-) Approx Remarks

Financial Year (Present Year/Past 2 Years)
Promotional Budgets Yearly (Approx)
Select Promotional budget yearly
Institute Photo
Drop files here or

Max. file size: 1 MB, Max. files: 5.

Current Occupations*
Select Choice of Online Association Plan*
How fast you planning to Start/Association with us*
How you here about us*
Prefer mode to contact you*
Prefer time to Contact you (After)*

(i.e 08:00 am / 06:00 pm)
Entre your one or more choice*
- Select All
- Ready to understand the Business Proposal
- Ready to Visit Nearest office to Understand
- Not intrested
Share any query related to association
Product Name
Quantity

Request for Empanelment

Complete the Full Empanelment Process

Request an Empanelment of Centre

Step 1 of 3

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Owner Name	Teach (Yes/No)	Experience	Modules teaches by you (i.e-tally, C, DCA , DTP)

Laptop/Desktop	Assembled/Company	Make/Brand	Processor Speed (MHz/GHz)	Memory (GB)	HDD (GB/TB)	Wi-Fi (Yes/No)	No.'s

Sl. No.	Peripherals Name	Make	Description	Qty (Present)

Sl. No.	Total Walk in Enq/month	Total Phone in Enq/month	Others	Total % Of Conversations/month