Request for New Connection

Please note: fields marked by (*) are required

Name of the institution:*

Address of the institution:*

Location where connectivity is required: *
Check this box if Location and Address are the same.

State:*

District: *

City: *

Number of users: *

Number of nodes: *

Request for bandwidth:*

Existing IT Infrastructure:*

Name of Contact Person:*

Official Contact Number (Landline):*

Mobile:*

Official Email Address:*

Research Projects Undertaken:

(Documents no longer than 500 KB, Only PDF is allowed.)

Letter from Head of the institution on letter head:

(Scanned copy required,no longer than 500 KB, Only PDF is allowed.)

Captcha letters are case sensitive,Use Upper Case Captcha