SKILL DEVLOPMENT DIVISION

Service Partner Form

A. Service Partner Details

Name of Institution^*:	It is required
Name of Director^*:	It is required
Pin Code^*:	It is required	Name of State^*:
Name of district^*:	It is required	Mobile No^*:	It is required
Address: (full address of the proposed site)^*:	It is required
Official Contact Details^*:	It is required
Email ID^*:	It is required	Aadhaar No ^*:	It is required

B. Centre Manager Details

Name of Centre Manager ^*:	It is required
Pin Code^*:	It is required	Name of State ^*:
Name of district ^*:	It is required	Mobile No ^*:	It is required
Address: (full address of the proposed site) ^*:	It is required
Official Contact Details ^*:	It is required
Email ID ^*:		Aadhaar No ^*:	It is required

C. Infrastructural details ^*:

If multi-storied building, the floors being proposed for training ^*:
Total built-up area (in Sq Ft) ^*:	It is required
Total compound area (in Sq Ft) ^*:	It is required
Type of Ownership ^*:	It is required
If Leased/Rented, Lease or rent tenure left ^*:	It is required

Approach Road ^*:	It is required
Front View ^*:	It is required
Back View ^*:	It is required
Reception Area ^*:	It is required
Domain Lab ^*:	It is required
Classroom ^*:	It is required
Washrooms ^*:	It is required
IT Lab ^*:	It is required

DECLARATION

This to certify that all the above information furnished regarding the Institution/ College is Correct and authentic to the best of my knowledge

Date:

(Signature, Head of the Institution)

Place:

(Name with Rubber Stamp):