INSTITUTE CODE NO :-

FORMAT-1
GENERAL INFORMATION ABOUT INST

PANCHAYA INSTITUT
S. DIST INSTITUTE ESTABLIS NO. OF SECRETARY
T E SOCIETY NAME
NO. RICT NAME HED YEAR UNITS NAME
SAMITTEE CODE

1 2 3 4 5 6 7 8 9

1
OUT INSTITUTE

NO. OF STAFF
MOBILE INSTITUTE PRINCIPAL MOBILE
NO. LANDLINE NO NAME NO.
NON
TECHNICAL
TECHNICAL

10 11 12 13 14 15

Seal & Sign of

Principal / Suprintendent
INSTITUTE CODE NO:- 0
FORMAT - 2
Information about sitting ca
INSTITUTE CAPACITY

CLASSROOM HALL WORKSHOP

S. NO. INSTITUTE NAME P. CODE

Sitting Sitting Sitting

NO. Capacity NO. Capacity NO. Capacity
1 2 3 4 5 6 7 8 9

1
 FORMAT - 2
bout sitting capacity of institute
PACITY

OTHER AVALABILITY OF
BROAD BRAND
NO. OF AVALABILITY OF
Sitting TOTAL FURNITURE ( YES/ GENERATOR
NO. Capacity CAPACITY AVAILABLE NO) (YES/ NO)
10 11 12 13 14 15

Seal & Sign of

Principal / Suprintendent
 AVALABILITY OF
MULTIFUNCATION
PHOTOCOPIER MACHINE
( YES/ NO)
16
INSTITUTE CODE NO:- 0
FORMAT -3
OTHER INFORMATIO

S. INSITUTE NEAREST POLICE STATION

INSTITUTE NAME DISTRICT
NO. CODE
POLICE STATION
NAME DISTANCE
1 2 3 4 5 6

1
 FORMAT -3
OTHER INFORMATION

NEAREST PNB BANK NEAREST OTHER BANK

DISTANCE FROM
PANCHAYAT
SAMITTEE
BRANCH NAME DISTANCE BANK NAME DISTANCE HEADQUARTER
7 8 9 10 11

Seal & Sign of

Principal /
Suprintendent
 DISTTANCE FROM
DISTRICT
HEADQUARTER
12

l & Sign of
 FORMAT-4
INFORMATION REGARDING INSTITUTE OWN CHOICE FOR EXAM

CHOICE FOR EXAM CENTRE (OTHER THAN SELF INSTITUTE

S. P. CHOICE NO. 1 CHOICE NO.2

NO. INSTITUTE NAME CODE (MENTION PCODE NO.) (MENTION PCODE NO. )
1 2 3 4 5

1
EXAM CENTRE

STITUTE/ SOCIETY)

CHOICE NO.3
(MENTION PCODE NO. ) REMARK
6 7

Seal & Sign of

Principal / Suprintendent