Raj Bhavan Program Management

A. PROGRAM DETAILS **(*)** Mandatory Field

1. Select Program Date Type*

Fixed Date

Flexible Date

2. Proposed Date & Time of Program*

Total Number of application already applied for this date

Forenoon	Afternoon	Evening

3(a) Program Type *

3(b) Program Information *
(Max 200 characters allowed)

4. Proposed Venue of Program*
(Max 200 characters allowed)

5. Distance of Proposed Venue (in KM) from the District HQ *

5.(a) Distance of Proposed Venue (in KM) from Bhubaneswar *

6. Expected Number of Audience *

7. Whether Hon’ble Governor had attended this event in past *

Yes

Date*

8. Revenue District*

9. Police District *

1. Organization Type *

2. Name of the Organization *
(Max 100 characters allowed)

3. Full Address of the Organization *
(Max 200 characters allowed)

4. Name of the Applicant *

5. Designation *

6. Proof of Identity*(Note: Please Provide Correct Information as the same would be verified with the hard copy.)

6(a) Identification Type *

6(b)Identification Number*

6(c) Identification Document *

(Max 1 MB - pdf, jpg, jpeg scan copy allowed)

7. Mobile Number *(Will be validated through OTP)

8. Email Address *

9. VIP Reference (if any)

10. Upload Related Document Note: If any VIP reference documents are available,then to be uploaded here.

(Max 1MB - pdf, jpg, jpeg allowed for each scan copy)

11. Organization’s forwarding letter * Note: Attach scan copy of Organization’s forwarding letter on Letter head with seal signature

(Max 1MB - pdf, jpg, jpeg allowed for each scan copy)