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Free Language Lab Exchange Form Institute Name : …………………………………………………………………………………….. Address : …………………………………………………………………………………………………………………….. ………………………………. state : ……………………….…… Pin code : …………..…………… Contact Person : …………………………………….

Designation : …………………………………………….

Phone No : …………………………………… Email Address : ……………………………………………………. website address : …………………………………………………………………………. Name of Installed Language lab : ………………………………………………………………………………….. Name of Company from bought : ……………………………………………………………………………… Address of Company : ………………………………………………………………………………………………. Bill No : ………………………….……………………..

Bill Date : …………..…………………………………..

Amount : ……………………………………………… No. of Users : …………………………………………...

Why do you want to Exchange your Language Lab : …………….…………………………………… ……………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………… Product/software problem :

Yes

No

Services problem :

Yes

No

Sig. & Seal of Principal/Director Please send this filled form to Mr. Gulshan Budhiraja (Installation Head) 41-42A Ashoka Park Main, Adjacent Main Ashoka Park Metro Station New Rohtak Road New Delhi - 110035


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