APPLICATION FOR EMPANELMENT OF DEVELOPERS FOR INSTRUCTIONAL MATERIAL, QUESTION BANK, E-CONTENT, TECHNICAL TRANSLATORS, TECHNICAL PROOF READERS & TECHNICAL EDITORS

1. Name (in Block Letters)

2. Date of Birth and Age

3.

Address for communication

4 a) Phone No. with STD Code b) Mobile noc) e‐Mail id

5.Educational Qualification

a) Academicb) Technical

6. No of years of experience

7.

Details of Experience in Chronological order

.( Please Attach Xerox copies of certificates pertaining to Qualification & Experience)

Sl no Name of the Area/Sector/Trade

No of years of experience in the relevant area/sector

No of translations published

1234

8. Any other relevant information :

DECLARATION

I ___________________________ hereby declare that the information furnished above are true to the best of my knowledge and belief. . In case any of the data/information found to be incorrect the application is liable to be rejected.

Place: Signature Date:

Note: The Executive Director, NIMI, reserves the right to reject the Application for Empanelment, without assigning any reason