Basic Information Collection Form

a. Contact Person Name: ______________________________________________________

b. CNIC Number: _______________-__________________-__________________________
c. Telephone Number: ______________________ E-Mail:
___________________________
d. Complete Address of the Computer Center :
______________________________________
___________________________________________________________________________
___________________________________________________________________________
e. Mauza: ___________________________Tehsil: __________________________________
f. District: ___________________________

g. Name of Supporting Organization (If Any):

_______________________________________
h. Address of the Supporting Organization (If Any):
___________________________________
________________________________________________________________________
i. Telephone Number: ______________________ E-Mail:
___________________________

j. Photographs of Telecenter (from outside) and equipment (inside): Yes ______

No _________
k. Number of years/months in Business: ___________No of PCs:
________________________
l. Number of Total Users:______________ Male: ____________ Female:
_____________
m. Any Other Information ______________________________________________________