CEP Registration Form
(Fields marked by * are mandatory)
Profile of the Applicant Institution
Name of the Appicant*
Permanent Address of the Applicant*
Name of the Centre*
Address of the Centre:
Building No.*
Building Name*
Street
Place*
Post Office*
District*
--SELECT DISTRICT--
Thiruvananthapuram
Kollam
Pathanamthitta
Alappuzha
Kottayam
Idukki
Ernakulam
Thrissur
Palakkad
Malappuram
Kozhikkode
Wayanad
Kannur
Kasaragod
Village*
Taluk*
Pincode*
Phone *
Mobile
Fax
E-mail*
Type of Local Body:*
Name of the Local Body where the Institution is to be started:*
Type of Organisation:*
Individual/Sole Proprietorship
Partnership
Public Ltd. Company
Private Ltd. Company
Co-operative
Registered Society
Trust
Self help group
Neighbourhood group
If Others Specify:
Year in which the institution started functioning:*
Total Number of computers in the Organisation:
Sl. No.
Processor Type
HDD
RAM
Number
1.
(Size in GB)
(Size in GB)
Details of Peripheral Devices
Internet Connection
Does the institution have an Internet Connection?
Yes
No
If yes, name of the Internet Service provider
Select Provider
BSNL
VSNL
Leased line
V-Start
Cable Connection
Printers
Printers
Other Peripherals
Sl. No.
Type
Number
Sl. No.
Type
Number
i)
Dot-matrix
i)
Scanner
ii)
Inkjet
ii)
Plotter
iii)
Laser
iii)
Others ( Specify)
UPS
Sl. No.
Power (in KVA)
Number
i)
ii)
Details of Available Software
Sl. No.
Name of the Software
Quantity
Licensed
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
5.
Yes
No
6.
Yes
No
Employee Details
Sl. No.
Category
Total No
Expenditure of Amount
1.
Professional
2.
Technical
3.
Managerial
4.
Maintenance
5.
Others
Whether the institution posses the affiliation of any other agency?
Yes
No
if yes ,please give details
Processing fee details
Payment Method
Select Payment method
Installment
Full payment
Amount to be paid at the time of registration
Rs 1000/-
DD Number *
Amount *
Date *
Bank *
I agree to abide the rules and instructions of CDIT in CEP affiliation
Designed & Maintained by: C-DIT, Thiruvananthapuram-27
www.cdit.org
