Photograph of

Centre Head

(An I.T & Vocational Training Awareness Programme)

Initiated By: E-Max Education I.T. & Educational Development (India)

An Autonomous National Organization for I.T, HRD & Literacy Works

An ISO 9001:2015 Certified Organization

Certified/Licensed by Central Govt. of India Central Registration Center Certificate of Incorporation Vide License. No.
India/MCA/CIN/U80211HR2016PTC063741,CRS License No. HRKKR201500328, ISO 9001:2015 Cert. No: UQ-8747 UK

APPLICATION FOR CENTRE AUTHORIZATION

(Use Capital Letters)

1. Name of Centre/Institutions/Organizations/NGO___________________________________________________________________
2. Name of Owner/President/Director_______________________________________________________________________________
S/o, D/o, W/o_______________________________________________________________D.O.B_____________________________
3. Address of Centre/Institutions/Organizations/NGO

Near_________________________________________________________________________________________________________

Village/Town/City_____________________________________________P.O_____________________________________________

Tehsil/Taluka_________________________________________________Distt_____________________________________________

State__________________________________ Pin Code__________________Ph.No________________________________________

Mobile No/s_________________________________________________________________Fax No____________________________

Active Email Address/s___________________________________________________Whatsapp Mobile No_____________________

4. Correspondence/Postal Address of Institutions/Organizations/NGO

Near_________________________________________________________________________________________________________

Village/Town/City_____________________________________________P.O_____________________________________________

Tehsil/Taluka_________________________________________________Distt_____________________________________________

State__________________________________ Pin Code__________________Ph.No________________________________________

Mobile No/s_________________________________________________________________Fax No____________________________

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Active Email Address/s___________________________________________________Whatsapp Mobile No_____________________

5. Date Opening Centre/Institutions/Organizations/NGO______________________________________________________________

6. Detail of Centre Infrastructure/Machinery/Equipment.

[A] No. of Computers/Machines (Required Min. 3 to 5) _________________ [B] No. of Chairs (Required Min.10) ________________

[C] Centre Area (Required Min. 100 Sq feet to 200 Sq feet) ______________ [D] Toilet/Urinal available (Yes/No)________________

[E] Scanner(Y/N)_____ [F] Printer (color/B&W) _________ [G] Internet Connectivity (Y/N)_____ [H] UPS/Inverter (Y/N)_________

7. Number of Faculty Members (Required Min-1).

Sr. No. Name Qualification

8. Applying for Centre Authorization of below Mentioned Zone/s (Tick on Require Zones)

Software Zone Hardware Zone Teacher Training Zone Vocational Zone All Zones

9. Authorization Fee –Payment Details

Centre Affiliation Fee Payment Date Paid by NEFT, Online/Mobile Banking Bank Name Payment Slip No.

Signature of Centre Head Left thumb Impression of Centre

Date
Head
of Submission Place

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 Centre Head/Owner/Director Profile

Centre Head Name

Centre Head Father/Husband Name

Centre Head/Owner
Color Photo
Date of Birth

Religion

Gender (Male/Female)

Language Known

Centre Head Permanent

Address
(Street/Sector/Village, Post
Office, Tehsil/Taluka/City,
District, State, Pin Code)

Qualifications
(Attach Copies of Certificates)

Experience (If any)

Active Email-ID

Home Landline Number or

Mobile No.

Centre Landline Number or

Mobile No.

(Provide At least two Active No.)

Centre Head WhatsApp Mobile No.

Centre Head Active Email IDs

Tell about your Family

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 Signature of Centre Head Left thumb Impression of Centre Head
Date of Submission Place

Declaration by Centre Head

I/We………………………………………………………………..S/o,D/o,W/o……………………………...…...……...…..…………………

…………Aged………………………R/o…………………………………….Permanent Address…………...….……………………………

……………………………………………………………………………………………………Pin Code…….……...…….………….………

Ph.No………………………………Mob………………………………………………...EmailID…………….……………………………….

Solemnly Affirm & Declare As Under:

1. That I/We, have established/opened Centre at____________________________________________________________________

__________________________________________________________________________________________________________
2 . Name of my/our centre is____________________________________________________________________________________

3. That I/We, have established/opened above mentioned Centre/Institute/NGO on (date)____________________________________.

4. That I/We have fulfilled all requirements to run authorized (Software Zone/Hardware Zone/Teacher Training Zone/Vocational
Zone/All Zone Courses) __________________________________________________________Centre/s or Course/s under
E-Max Education (An I.T & vocational Training Program me of E-Max India I.T & Educational Development -HR) in my/our
centre/Institute/NGO.

5. That E-Max shall issue authorization to run abovementioned zone/s courses, for abovementioned single location/address of my/our
centre & the same authorization shall not applicable to my/our franchise/branch at different locations, for this, I/we shall separately
submit new application for centre authorization for that franchise/branch at different location/address, The Branch Should not deal

with any other organization on behalf of itself

6. That I/We shall remain liable for every due towards E-Max in every circumstance

7. That E-Max has no sharing in student Admission fee/tuition fee/exam fee & all said fees will be prescribed/decided by me/us in
my/our centre as per investment, infrastructure facilities, student & teacher ratio, backwardness & geographical condition of
my/our area. E-Max shall not be held responsible if any dispute arises for said fees & I/We shall be solely liable for the same.
E-Max shall charge onetime nominal registration fee as per the duration of course/s per student/s.

8. That E-Max shall not invest/has not invested in my center/Institute set up, So all Investments, expenses and formalities relating to
operation of my/our centre shall be managed & borne by me/us such as- computer systems, centre furniture, centre teacher’s
salary, centre building (rented/self owned), educational legal Softwares, Centre Audit, Centre ITR, Centre Taxes (all types), local

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 level NOC etc.

9. That I/We shall get student/s diploma/certificate via post at my/our centre/postal address, which are certified/issued under I.T.
Vocational Training programme of E-Max Education

10. That all types of payments paid, to be paid to E-Max, shall not be refundable in any case, whatsoever.

11. That E-Max shall not be liable for any commitment or any scheme or any advertisement or tie-up, with students, govt., corporate,
universities, public & other organizations of same nature, which I/We run on my/our personal level in my/our centre.

12. That I/We found involve in any criminal, financial, social or any other offence then the authorization of my/our centre shall

automatically come to an end.

13. That the authorization of my/our centre/Institute/NGO shall be valid from _______________________________________&

the same shall be renewed in the month of March every year (before 31st of said Month) if I/We fulfill the condition applied for the

said renewal.

14. That E-Max shall have full right to update/modify/change/add, any rules & regulations pertaining to my/our centre

association/authorization/activation with E-Max.

15. That I/We have read and understood the rules & regulations of the E-Max & accept the same. In case of infringement/non
compliance by me/us, of any rules & regulations made in any application/form/document/file/webpage of emaxindia.in of
E-Max, then, Director of E-Max shall have full right to take decision upon further activation/authorization of my/our centre & in
this regard, his decision shall be acceptable to me/us.

16. All the Data regarding the branch office should be sent on the E-Mail of the head office in excel sheet format before 10th of every month

16. At least 30 Admission Should be done in a Financial Year

17. All the Dues Should be submitted in the head office before 10th of every Month

18. ID-Cards are Compulsory for Teachers as well as for students.

18. If any Person found guilty in any wrong doings in the branch, then Head of the Branch Head will be responsible for those wrong

doings and head office will not take any responsibility for those offences

Only after complete satisfaction, this declaration is being made which can be used for legal purposes as and when necessary against
me/us. In the event of any dispute/matter, it will be settled by the committee appointed by the E-Max -HR & its decision will be binding
on all concerned or at the court Kurukshetra (HR) & I/we will be liable to all the expenses.

Therefore, I/we_________________________________________________________Hereby declare & accept that the information

furnished in this Declaration from and the information furnished in the Application for Centre Authorization & Centre head Profile for
running courses under I.T & Vocational Training Programme of E-Max are true to the best of my/our knowledge and belief and & will
remain in force, binding & acceptable on me/us, my/our successor for the period of my/our center’s association with the E-Max.

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Signature of Centre Head Left thumb Impression of Centre Head Date of Declaration Place

Note: Enclose/Attach the following documents along with this Application form:
1. Attach- Centre Head/Owner/President/Director, Qualification copies, ID Proof- Aadhar Card, Voter Card.

2. Attach- Centre Front Photo, Centre Rooms/Lab Photo (If Centre Accommodation is not ready then send via email mentioned
photos with in One Month from the date of centre authorization)

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