SKILL
DEVLOPMENT DIVISION

Service Partner Form

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

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

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

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

Date:

(Signature, Head of the Institution)

Place:

(Name with Rubber Stamp):