Company Name *:

Owner Name *:

Title:

Authorised Person Name *:

Title:

Address (Put all addresses if you have more than one office) *:

Phone-1 *:

Phone-2:

Fax-1:

Fax-2:

eMail-1 *:

eMail-2:

Website:

Company History/Profile ( Please specify your principal activities):

Please indicate your Relevant Experience/Experience in Educational Sector & the length of time your organization has been actively involved in student recruitment:

What is the strength of staff in your company? (Ex: Counselor/Administrator) Total: Counselor's Administrative

How many students does your organization successfully place with abroad higher education institution each year:

Do you have more than one office in your city Please specify:

Do you have offices in other cities? Please specify:

Are you/your Agency member of any Association/Institution? Please specify:

Do you represent any other institutions/universities in abroad countries ( USA, UK, Canada, Australia, Ireland or others)?:

Do you represent any other Indian institutions? Please specify ( Ex: copies of certificates / testimonials etc.):

How do you promote your business? ( Ex: Advertise, TV, Radio, Magazines, newspaper etc. [enclose samples]):

What are your strengths that we should consider for appointing you as our Business Associate? ( Ex: Spacious office, experience, staff, networking etc):

What Promotional Activities regularly undertake by you? Please specify:

Services Provides to Students:

Other Services Offered:

What is your main line of service? Please specify:

Business Reference (Provide Two):

Student Reference (Provide Two):

Any further information you wish to provide at this stage:

IT PAN No:

Bank Name:

A/c No:

Bank Address:

Yearly Approximate no of students that you expect to recruit:

Please send the following documents to this address:

Valmiki Group
10-3-167/A, IInd Floor
St. John's Road
Opp Wesley Degree College for Women
Secunderabad 500025

Documents to be send