GOVERNMENT OF MEGHALAYA
APPLICATION FORM FOR REGISTRATION OF CYBER CAFES
UNDER MEGHALAYA CYBER CAFE RULES 2012

Enclosures Required:
1. Identity Proof :EPIC/PAN/Passport/Others.
2. NOC from Headman/Nokma
3. Registration Certificate of Shops and Establishments
4. NOC from Shop Owner (if Rented Premises)
5. Building Fitness Certificate/Fire Safety Certificate/Electrical Safety Certificate [Optional while form submission] - May be asked later depending on the Establishment
2. Registration of Society certificate is manadatory if Registered as a society.

Service Type

Type of application *

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Fresh

Renewal

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Previous Registration Number *

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Application Details

Full name of Applicant/Proprietor *

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Name of the Establishment/Cyber Cafe *

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Date of incorporation of Cyber Cafe *

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Type of ownership *

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E-Mail *

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Mobile Number *

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Are your registered with Registrar of Firms/ Registrar of Companies or Societies *

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Yes

No

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Category of Premises *

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Types of services to be provided *

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Other Details of Applicant

Permanent Residential Address *

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Present Address *

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Occupation *

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Father's/Husband Name *

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Date of Birth *

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Address of Establishment/Cyber Cafe

District *

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Locality *

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Nearest Landmark

Police Station *

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Pincode

Other Details of the Establishment

E-Mail Address of Cyber Cafe *

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Telephone No. of Cyber Cafe *

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Approximate Area of Premises *

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Lisence Period of Tenancy/Lease/License *

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Name and Address of the Premises Owner *

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Declaration

This is to certify that the information furnished as above are true to the best of applicant's knowledge and belief and that the applicant would be liable for prosecution if found otherwise. Also, the applicant will abide by the conditions of the lisence when granted.

I Agree *