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APPLICATION FOR VERIFICATION OF TITLE

1. Name of the applicant

(in CAPITAL LETTERS)

2. Name of the Owner

3. Nationality

4. Complete Address

5. Educational Qualification

6. Professional/Income

7. Name of titles

(in order of preference)

8. Language of the proposed publication

9. Periodicity

10. Place of Publication with full address

11. Weather the titles are same/similar to titles of

prominent foreign publication. If yes, then

attach copy of NOC from M/o I&B or license

agreement with foreign title owner to publish

the title in India.

12. Pan Card Number

13. Election ID card copy

(Duly attested by G.O.)

14. Name and Address of Printing Press

15. a) Contact No.

b) E-mail ID

16. Does the owner have any titles previously

allotted by RNI? If any, its status

HEMANTKUMAR MAHESHKUMAR VYAS

HEMANTKUMAR MAHESHKUMAR VYAS

INDIAN

A-138, SHREYANSNATH SOCIETY, NEAR VYASWADI

KATHWADA ROAD, NARODA, AHMEDABAD - 382330

M. PHIL (PHYSICS), M.TECH. (VLSI)

57484 /- INR

1. MEHSANA SUDARSHAN

2. MEHSANA DARPAN

3. GARVI MEHSANA

4. MEHSANA SAMBODHAN

5. MEHSANA WEEKLY

ENGLISH, GUJARATI & HINDI SINGLE AND/OR MIXTURE

WEEKLY SINGLE (AND/OR SPECIAL EDITION BASED ON

CIRCUMTANCES)

MEHSANA (NORTH GUJARAT)

NO

AJYPV7831M

MCS7808959

Free Lancing (On agreement base to vender)

+91 94 266 96 244

professorhmvyas@hotmail.com

NO

Applicant’s Signature