INSTITUTE Of WILP

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APPLICATION FOR WILP ACADEMIC PARTNER

Proposed Academic Partner Profile

Name of Institution

Type of Institution

Name of the organization running the Institution

Date of organization

Registration Number of organization

Postal Address of Institution

STD Code

Contact Number

Fax Number

Mobile Number

E-mail Address

Website Address

Pan Number of Institution

Address proof of the Institution

Details of Managment/Head of Institution

Name of Head of Managment

Designation

Postal Address

Educational Qualification

Photo

STD Code

Contact Number

Fax Number

Mobile Number

Alt Mobile Number

E-mail Address

Profession & Experience

PAN Number

Infrastructural Facilities

Location of Institution

The building of Institution

Total Carpet Area of Institution (In Sq.Ft.)