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 ______________________________________________________

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