Centre Activation Web Form

Branch/ Institute Name (If not available, You can use FACT® Brand Name)

Full Name of Centre Director *

Layout (copy)

Father's Name *

Centre Email ID *

Date of Birth *

Centre Director Phone Number *

Layout

Centre Alternate Contact Number

Centre WhatsApp Number (If Available)

Institute/ Study Centre Full Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Permanent Address (If Same as above, Don't Fill this)

Address Line 1

City

State / Province / Region

Postal Code

Country

Facilitied Availble at Centre

Layout

Number of Computers

Space (Approx in Sq feet)

Number of Faculty/ Trainer

Number of Students (Current)

Any Other Information in your Words.

Passport Size Photo of Director

Click or drag files to this area to upload. You can upload up to 2 files.

Max 1 MB File Size Allowed

PAN Card

Click or drag files to this area to upload. You can upload up to 2 files.

Max 3 MB File Size Allowed

Aadhar/ UIDAI Card (Attach Front & Back)

Click or drag files to this area to upload. You can upload up to 2 files.

Max 4 MB File Size Allowed

Last Education Certificate

Click or drag files to this area to upload. You can upload up to 2 files.

Max 4 MB File Size Allowed

Label *

I hereby declare that all the above details/ information & attached documents are correct and verified by me.