Registration Form

To

JD Education Group


We are submitting our consent to provide you the required infrastructure for the Centre to be conducted by you with following details.

(A) Institution Details

(B) Personal Information

S.No.	Designation	Name	Email ID	Mobile Number
1.*
2.
3.
4.
5.

(C) Infrastructure Details (Select One from each)

S.No.	Room Type	Furniture	Air Conditioned	Seating Capacity
1.	Select Hall Room	Select Table Chair Bench Other	Select Yes No
2.	Select Hall Room	Select Table Chair Bench Other	Select Yes No
3.	Select Hall Room	Select Table Chair Bench Other	Select Yes No

(D) Documentation

Centre Head Photo :
Type of Exam (Theory / Practical) :	Theory & Practical
Date of Exam :		Time : 9:00 AM to 7:00 PM
Expected Number of Students :

I hereby certify that the information provided above is true to the best of my knowledge and belief. If any information is found to be false/ incorrect, it will reject my centre in JD Education Group , HISAR.

Yours Truly

Name :
Designation :
Date :