Center Name	*		Centre Head	*
	Occupation	*		Educational Qualification	*
	Others Qualification			Postal Address of Director	*
	Mobile No of the Center Director	*		Pan number of center director
	Village			P.O	*
	P.S	*		Block/Municipality	*
	Dist.	*		PIN	*
	Area	*		Contact No.	*
	Email	*		Establishment Since

ROOM NAME	NO OF ROOMS	AREA IN SQ FEET
CENTRE HEAD ROOM
RECEPTION ROOM
CLASS ROOM
PRACTICAL ROOM / LAB
NO OF COMPUTER/PRINTER/SCANNER/WEB CAM
WAITING ROOM
NO OF TOILET

INTERNET CONNECTIVITY OF CENTER : YESOR NO(PLEASE TICK)
POWER BACKUP AT CENTER : YESOR NO(PLEASE TICK)
YOU ARE PRESENTLY : RENTEDOR OWNED(PLEASE TICK)

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*

All the information given above is true to the best of my knowledge and nothing is concealed therein. I have read and understood the rules and regulation made by the NCCE India and accepts the same.