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.