Enquiry Form

Network Partner Entry Details

Membership Type   Offer Code  
Offer Code   5912f07fb6a89  
Name of the Organization/Center offercode *  
Type of Organization *  
State *  
District *  
Tuluka/Block *  
City *  
Owner Details:
Owner Name/ Competent Authority *   Birth Date
Gender   Male Female  
Role *    
Contact Details:
Email: *   Mobile Number: *
Identity Proof:
Select your Identity Proof *   Card Number: *
Date of issue:   Place of issue:
Brief profile:

We, Applicant Organization (AO) understand and agree that -
(i) The location of the proposed Centre shall be fixed only in the specific Area as selected by us and the selected location shall not be changed by us anytime during, and subsequent to the 'Network Partner Registration Process,
(ii) KBVTI reserves the right-
(a) To modify the terms and conditions of the Network Partner Registration Process without any prior notice and KBVTI shall not be liable to anyone for any such modification/s;
(b) To discontinue/postpone the Network Partner Registration Process (or any part thereof) with/without prior notice and KBVTI shall not be liable to anyone for any such discontinuation/postponement;
(c ) Of granting and/or rejecting authorization to any applicant/s, without assigning any reason/s whatsoever to anyone.
(iii) In case we are granted authorization-
(a) We are responsible for maintaining the confidentiality of the password and login account given by KBVTI and fully responsible for all activities that occur thereunder;
(b) We shall abide by the various guidelines, communications, norms issued and specified by KBVTI from time to time,
(iv) All the disputes or differences, if any, prior and/or subsequent to authorization (if granted) shall be referred to the courts in Bhubaneswar, which shall be the courts having the jurisdiction to entertain and try the same.