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AFFILIATION INFORMATION REPORT
FINANCIAL YEAR (2021-2022)
TO BE FILLED IN ENGLISH CAPITAL LETTERS ONLY

PART (A) TO BE FILLED BY THE PERSON SIGNING THE AGREEMENT

1. Date of Agreement :
2. State :
3. Region :
4. Constituency :
5. District :
6. Block :
7. Panchayat :
8. City/Place/Village :
9. Nearest Place/Land Mark :
10. Center owner's name :
11. Father/Husband name :
12. Date of Birth :
13. Date of Marriage anniversary :
14. Gender : Male  Female 
15. Qualification (Centre Owner) :
16. Center Co-ordinator’s name :
(In case owner is not Co-ordinator)

17. Center Address if Center is existing

Firm Name :
Address :

Pin :
Phone (with STD Code) :
Mobile No. 1 :
Mobile No. 2
Fax (with STD Code) :
E-mail 1 :
E-mail 2 :
Website :
18. Aadhar Number (Centre Owner) :
19. Pan Number (Centre Owner) : ___________________________________________
20. Bank Account Details (Centre Owner) : Bank Name _________________________________
: Bank Branch Address _________________________
___________________________________________

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 : Account Holder Name._________________________
: Account No._________________________________
:
: IFSC Code : _________________________________

NET BANKING : Yes No

21. Residence Address of owner :

Address :
:
City :
District :
State :
Pin :
Phone (with STD Code) :
Mobile No. :
22. Nature of field Area :  Rural  Urban  Tribal  Industrial
23. Nature of Centre (Tick on : State Capital Industrial Area District
appropriate)
Block Panchayat Village
24. Distance From Nearest (KM) : Airport:______ Train Station: ______ City Centre: _____
25. Mandatory documents : Please attached photocopy
 Passport Photograph attached
 Aadhar Card (attached Photocopy)
 Photo ID Proof (attached Photocopy)
 SBI Account Number (attached Cancel Cheque)
 Pan Card (attached Photocopy)
 Branch Manager Residence Proof (attached Photocopy)
 Attach Registration Certificate of Firm / Society / Company as the case
may be
 Branch Manager Bio-data (attached Photocopy of Bio-data )
 Faculty Bio-data (attached Photocopy of Bio-data )

26. Centre Premises Details : Total Area In Square Feet: ______________

Reception (Area in Square feet) ___________ Office (Area in Square feet) ______________

Class Room 1 (Area in Square feet) __________Seating Capacity_____________________

Class Room 2 (Area in Square feet) __________Seating Capacity_____________________

Lab1 (Area in Square feet) _________________ Seating Capacity _____________________

Lab2 (Area in Square feet) _________________ Seating Capacity _____________________

Library (Area in Square feet) _______________ Seating Capacity _____________________

Staff Room (Area in Square feet) ____________ Seating Capacity _____________________

Counselling Room/ Placement Cell (Area in Square feet) _______ Seating Capacity _______

Cafeteria / Dining Room (Area in Square feet) _______ Seating Capacity ________________

Residential Training facility (Area in Square feet) _______Capacity (no. of candidate) ______
Physically Disabled Friendly: Yes No

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 No. of Female Toilet ____________________ No. of Male Toilet ______________________

Parking Area (Area in Square feet)___________ Any other ___________________________

First Aid Kit Availability: Yes No Fire Safety Equipment: Yes No

27. Type of Centre ownership (Tick one option) : Owned Leased Rental Partnership

28. Hardware Details :

No. of Computers:__________ (Please attached details with description)

Printers; Laser: _________________InkJet :______________Other_______________,
Digital Camera _________________, CCTV Camera.__________________________,
Biometric Device _________________, LCD/Projector_________________________,
Scanner ________________________, AC__________________________________,
Power Backup ______________________3 Phase Power Connection: Yes No
Water Cooler__________________ Any other___________________________________,

29. Connectivity Type : FWT CDMA WLL

Broad Band Mobile EVDO

Data Card USB Modem Dialup
Company Name :_____________________________________________

30. If center is other than IT Academy, please enclose list of available

Tools & equipments. : Yes No

31. Software Details : :

Operating System Window Window Window Other

Window 98 Window Me Window XP
Software available 2003 2007 2010

Licensed Tick Y/N

(Attached Copy)

Licensed Application
Software Available
(Give Name)

32. Do you run a school : Yes No

If, yes at what Level : Higher Sec. High School
Middle School Primary Play School
33. Do you run a Coaching Centre : Yes No
If, yes for whom : ___________________________________
34. Are you conducting any other training (Govt./Private)
Apart from AISECT’s : Yes No
If Yes Please specify Scheme and trades of training. __________________________________
_____________________________________________________________________________
35. Faculty Details: Receptionist Name: _____________________ Qualification: ____________
Total No. of Faculty: ____________________________________________________________

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 (A) FULL TIME
Sl. No. Name Academic / Technical Qualification Experience
1
2
3
4
5

(B) PART TIME

Sl. No. Name Academic / Technical Qualification Experience
1
2
3
4
5

(C) ASSOCIATE
Sl. No. Name Academic / Technical Qualification Experience
1
2
3
4
5
Note: Enclose faculty Bio-data.
36. Branch turnover for the last three years : 2020 - 2021 ___________________________
2019 - 2020 ___________________________
2018 - 2019 ___________________________
37. Centre Photographs:

(1)
Front View

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 (2)
Reception / Counseling Room

(3)
Lab

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 (4)
Class Room 1

(5)
Class Room 2

Date: Seal and Signature of Centre Owner

Name:

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 FORWARDING SHEET 2021-2022
TO BE FILLED BY THE REGIONAL MANAGER / BUSINESS DEVELOPMENT EXECUTIVE
1 New Enquiry Generated by :
.
2 Centre initiated by : H.O. RM BDE
Other PI. Specify
3 Assigned Category Level : State Capital Big City District Block Panchayat

Aff_Fees Charged Aff_Fees Deposited Aff_fees Balance (If any) REMARK

Product Name
Fees S. Tax Fees S. Tax Fees S. Tax
AISECT Academy for IT &
Management
AISECT Academy for Hardware &
Networking
AISECT Academy for Livelihood &
Vocational Training

AISECT Academy for Banking,

Financial Services & Insurance
AISECT Academy for Agriculture &
Food Processing

AISECT Academy for Teachers

Training
AISECT Academy for Marketing &
Retail
AISECT Academy for Apparel and
Fashion Design
AISECT Academy for Tourism &
Hospitality
Academy for Beauty and wellness

AISECT Future Skill Academy

AISECT Academy for Foreign
Language
AGU (Referral Center)

Multi Service Centre

Banking Kiosk

RFID/ETC

OTHER ( )
TOTAL

Mode of Payment- DD No. ------------------------- Bank Name----------------------------- Date-------------------

Online (Please Attach Transaction Slip Other--------------------

Total Affiliation Fees Deposited :

Date:

Signature & Name of Signature & Name of

Business Development Executive State Coordinator / Regional Manager

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 FORWARDING SHEET 2021-2022
PART (B) TO BE FILLED BY THE AISECT CO-ORDINATION & ACCOUNT SECTION
1. New Enquiry Generated by :

2. Centre initiated by : H.O. Advertisement RM/BDE Seminar/Workshop

Other PI. Specify
Centre Code Allotted: _________ RM Name: ________________ Initiator: __________________________

Vacant Dist. : _______________ Remark: _______________________________________________________

3. Assigned Category Level : State Capital Big City District Block Panchayat

Aff_Fees Charged Aff_Fees Deposited Aff_fees Balance (If any) REMARK

Product Name Fee
Fees S. Tax Fees S. Tax S. Tax
s
AISECT Academy for IT &
Management
AISECT Academy for Hardware &
Networking
AISECT Academy for Livelihood &
Vocational Training

AISECT Academy for Banking,

Financial Services & Insurance
AISECT Academy for Agriculture &
Food Processing

AISECT Academy for Teachers

Training
AISECT Academy for Marketing &
Retail
AISECT Academy for Apparel and
Fashion Design
AISECT Academy for Tourism &
Hospitality
Academy for Beauty and wellness
AISECT Future Skill Academy
AISECT Academy for Foreign
Language
AGU (Referral Center)
Multi Service Centre
Banking Kiosk

RFID/ETC
OTHER ( )
TOTAL

MODE OF PAYMENT- CASH /DD No. Date :___________ BANK NAME: ____________________

Total Affiliation Fees Deposited :

Receipt Date :
Receipt No.

Date : Prepared by Co-ordination Section Account Section

PART (C) TO BE FILLED BY THE DATA BASE SECTION
Receipt Date: Remark (If any):
Process Date: Signature Database:

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