CENTER REGISTRATION

center application form

Application for center approval for

IEPTO POWERED COACHING CENTER

PATH EXAM CENTER

CENTER / INSTITUTE NAME

Organisation Type

Reference No.

Company PAN

Correspondence Address

Location

Owner / Authorised Person / Director

Applicant Name

WhatsApp No.

Aadhar No.

Email*

Email OTP*

BirthDate

Age

Gender*

Male

Female

Designation

Pan No.

Alternate Person Name

WhatsApp No.

Center / Branches In City / Town

Date Registered

ISO Certified

Yes

Internet type

Internet Speed

No. Of PC ( Intel only )

Space Available

Bank Details
Your incentive will be credited to this account

Account Name

Account Number

Bank Name

Branch Name

SWIFT / IFSC code

Account Type

Other Similar Franchisee held

No. of students enrolled yearly

No. Of Employees

Teaching / Faculty Nos.

List 5 PIN Codes which are within 25 Km to your center

PIN 1

PIN 2

PIN 3

PIN 4

PIN 5

No. Of Benches / Student capacity

STD.7	STD.8	STD.9	STD.10	STD.11	STD.12	TOTAL

Upload Owner Photo

allowed only jpeg, jpg, png, max size : 1MB

Upload cancelled cheque

allowed only jpeg, jpg, png, pdf max size : 2MB

Security Code

center registration

center application form

Owner / Authorised Person / Director

Bank Details Your incentive will be credited to this account

List 5 PIN Codes which are within 25 Km to your center

No. Of Benches / Student capacity

Notification

Bank Details
Your incentive will be credited to this account