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Partner

INDU

MAN

Application

A. Institute / C

1. Name of In

2. Postal Add

3. Contact Detail

Invites application to become a

of our N.C.V.T / M

pproved Courses

TRIAL FIRE & SAF

AGEMENT ACADE

orm to become New Trainin

entre Details:

titute / Centre

ess

s

HRD

TY

Y

Centre

1

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B. Registered Society / Tr

C. Details of All members /

Sr.Name of all Trustee

/ Partner

D. Co-ordinator / Represen

1 Name of the Co-ordi2 Qualification3 Contact Details

1 Type of Organization

2 Registered Name

3

Address

Building

Land Mark

City / Town

State

Pin Code

4

Contact Details

STD Code

Landline No.

Mobile No.

Fax No.

E-mail ID

Website

5 Registration No. of S

6 PAN No. of Society /

ust / Partnership / Proprietorship Details:

Trustees / Directors / Partners:

s / Directorss

Contact No.

ative Details:

nator

Society Proprietorship Pa

Trust Company Ot

ciety / Trust / Company / Partnership

rust / Company / Partnership

E-mail ID

2

tnership

er

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E. President / Chairman /

F. Infrastructure Details:

1 Location of Cetre / In

2

Building of Cetre / In(Enclosed Ownershi

Agreement Documen

3Whether the premise

what it is currently u

1 Name of President // Trustee / Director/ PProprietor

2 Residential Address

3 Contact Details

4 Educational QualificCourse

5 Professional Experie

Organization D

Trustee / Director / Partner / Proprietor:

stitute Area

titute is/Sale Deed /Rent

ts)

is ready for use? If yes

ed for

hairmanartner /

tionInstitute / Board / University Subject Y

nce

signation BusinessType

From To TurOv

3

ear of Passing

n-r

TotalStaff

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G. Declarations:

I / We hereby declare that theknowledge.

Date:

Place:

-----------------------------

Note : Filling up the above Aauthorization to open the Inddiscretion of IFSMA to accep

4

Location

5 Connectivity

6 Institution Facility

7 Grade your Centre

8 Justify your Grading

details provided by me/us herein above are true t

Signature with Seal

------------------------------------------------------------------------

plication Form does not indicate that the applicanustrial Fire & Safety Management Academy Author

or reject the same, without any reasons.

best of my / our

-

t has been given theised Centre. It is the

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Cheque / DD No.:

Drawn on (Bank Name)

Amount (In Figures) Rs ....

Amount (In Words) Rs ....

Photograph of Chairma

Signature & seal of Chairman

Society / Trust

(In original, with date)

Processing Fees / DD Details

.. Cheque / DD Date.:

n Photograph of Director

of Signature & seal of Chair

Society / Trust

(In original, with date)

..

.

.

..

.

..

an of

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H. Check List for Submission of Application Form:

Sr. Particulars Yes No

1Application form for New Admission & Information Centre

(Form should be completely filled)

2 Society / Trust / Company / Prop. Registration Papers

3 Society / Trust / Company / Prop. Board Resolutions

4Ownership / Sale Deed / Lease Deed / Rent Agreement

Document

5 PAN Card of Society / Trust / Company / Institute

6 Email ID & Contact Details

7 One Blank Letter Head & Visiting Card

8 Voter ID / Passport / Driving License / PAN Card the CentreDirector (Minimum of 2 documents Should be Attachment)

9 Undertaking of Institutes Letterhead

10 Others (Please Specify)

INDUSTRIAL FIRE & SAFETY MANAGEMENT ACADEMYA-605, Ashwamegh Complex, Opp. Sayaji Vihar Club, Rajmahel Road, Kirti Stumbh,

Vadodara 390001Website: www.ifsmavadodara.com

E-mail: infoifsma_vadodara@yahoo.comPh. No. : 0265-3390585, 9586528954

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