APPLICATION FOR TITLE VERIFICATION

(FOR SUBMISSION TO FORWARDING AUTHORITY CONCERNED IN THE CITY/DISTRICT i.e

DM/SDM/CMM/JMM/DCP etc.)

Code No. to be used only for reprint:

2017099146
(Please Check message in your email for reprint)

Note:- (Kindly affix seal and signature of forwarding authority on each page separately.),
(Overwriting/Cutting/Editing and use of white fluid is not permissible in the Application. )

Ownership Category INDIVIDUAL

Please paste a Passport size

Ownership
photo grapgh
Nationality(For Individual Owner) INDIAN
Registration No. of Non-Individual
Owners(Company/Trust/Society/Firm etc.)
Whether Owner has any Foreign Direct
NO
Investment in the business?
Name of the Owner of the proposed Title in
BIPIN SASI
English
Name of the Owner of the proposed Title in
िबिपन सिस
devnagri script(Hindi)
HX 15 KANHA KUNJ KOLAR ROAD ,
Complete Address of the Owner
District-BHOPAL ,State-MADHYA PRADESH
Name of Applicant in English(Individual or
BIPIN SASI
Person authorized by Non-Individual Entity)
Name of Applicant in Hindi(Individual or person
authorized by Non-Individual Entity)devnagri िबिपन सिस
script (Hindi)
HX 15 KANHA KUNJ KOLAR ROAD ,
Complete Address of the Applicant
District-BHOPAL ,State-MADHYA PRADESH

Date of Birth(Applicant) 5/4/1983

Landline Contact No.(with STD code) Fax
Mobile Number 9826178650
Email-id bipin514@gmail.com
Photo ID proof of Applicant (Self attested photo
AADHAR CARD NO-356918042795
copy to be enclosed with the Application)
HX 15 KANHA KUNJ KOLAR ROAD,
Complete Address Of Place Of Publication District-BHOPAL ,State-MADHYA PRADESH
,Pin Code-462042
State of Proposed Publication MP
City/District of proposed Publication
Language/s in which proposed Publication is to
ENGLISH
be printed in each & every issue
Periodicity of proposed Publication BI-MONTHLY
Name of proposed Titles in English(Option in order of Prefrence). Write in manner it would be
written in Hindi/English and meaning in english if proposed Title is in english language othe than
English/Hindi

1.
INTELLIGENT INDIA इं टेलीजट इं िडया INTELLIGENT INDIA

Meaning of Nature & Content to be published in proposed publication

WITH THOUGHTFUL ANALYSIS AND FEARLESS VIEWS
OUR TEAM OF EDITORS AND WRITERS WILL TRACK
NEWS IN INDIA AND THE WORLD AND PROVIDE A
PERSPECTIVE THAT IS REFLECTIVE OF CHANGING
Content of Publication
DYNAMICS. THE INTEND IS TO DISSEMINATE
INFORMATION RELATED TO THE GOVERNMENT
SECTOR WHICH IS USEFUL TO VARIOUS USER
GROUPS AT LARGE.
Whether the proposed Titles are same/similar to
NO
Titles of Foreign Publication
Does the Owner have any Titles previously
verified by RNI? if any, Please specify as NO
follows(if more,enclosed list)
List Of Name of Registered Titles Registered with same Owner.

List of Titles Verified in the Name of same Owner but not Registered.

Signature of Applicant ............................

 Date:- ..................

FOR OFFICIAL USE OF AUTHORISED AUTHENTICATING/FORWARDING AUTHORITY

AS PER PUBLICATION DISTRICT

Note:- (Kindly affix seal and signature of forwarding authority on each page separately.),
(Overwriting/Cutting/Editing and use of white fluid is not permissible in the Application. )

Office ref.no. Seal/Stamp Name & designation,phone Signature of

of no & email of forwarding forwarding
Authority authority authority

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