INSTITUTION REGISTRATION FORM
PLEASE FILL YOUR INSTITUTION DETAILS AND SEND IT TO YOUR CONCERNED BRANCH FOR
REGISTRATION.ALSO ATTACH A COPY OF YOUR AFFILIATION LETTER.
Note: All the fields are mandatory and provided information must be correct.
Institute Code ______________ Branch Code/Name ____________ Institute Gender _______
Affiliation Type: 1. Permanent Provisional
Institution Type: 1. Government 2. Semi Government 3. Private
Institute Name ________________________________________________________________
PTCL _________________ District _________________
Address ______________________________________________________________________
_____________________________________________________________________________
Please provide the IT admin details. (He will be authorized to login and use the online portal.)
Admin Name: ______________________ Admin Phone Number: __________________
Designation: __________________________ Email Address _________________________
Date: Signature & Stamp of Head of Institution