10.07.2015 Views

REGISTRATION FORM ( For Procurement of ... - (IMD), Pune

REGISTRATION FORM ( For Procurement of ... - (IMD), Pune

REGISTRATION FORM ( For Procurement of ... - (IMD), Pune

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RENEWAL <strong>REGISTRATION</strong> <strong>FORM</strong>(<strong>Procurement</strong> <strong>of</strong> Meteorological Data for only one year after completion <strong>of</strong> one year in registration)1 Name2 Affiliation and Research Institute3 Country4 Complete Postal Address <strong>of</strong> the Institutewith contact phone and Fax No.5 E-Mail Address6 Field <strong>of</strong> Research / Specialisation7 Purpose <strong>of</strong> procurement <strong>of</strong> MeteorologicalData ( Please briefly mention the details <strong>of</strong>the approved research plans,etc. ) Abouthalf a page8 Is your Project funded internally orexternally ? Pl. give the details9 Registration number with <strong>IMD</strong>10 Detail <strong>of</strong> renewal registration chargea) Amountb) Demand draft numberwith issued datec) Drawee Bank / BranchSignature


CERTIFICATE OF UNDERTAKINGIt is certified thatI / we agree to abide by all the terms and conditions as laid down by <strong>IMD</strong>with regard to procurement <strong>of</strong> meteorological Data.SIGNATURE OF THE REQUESTING PARTY(COMPETENT AUTHORITY AND SEAL)FOR <strong>IMD</strong> OFFICE USEVERIFIED /SCRUTINISED THE DETAILS : ----Institute (name & Address)REGISTERED AS RES. INSTITUTE / SCIENTIFIC ORGANISATIONREG. NO. : ----------SIGN OF THE OFFICER (HEAD, <strong>IMD</strong>)

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