The document contains a form requesting specimen course materials for a college student. It requests the student's personal information including name, designation, phone number and email. It also asks for course information including the course(s) and subject/semester for which specimens are required, as well as book titles, authors and publishers. Contact information is provided for textbook sellers and the college administration.

1. College Information
Personal Information
Name
Designation
Phone
Email
COURSE INFORMATION
Course(s) for which the specimen(s) required :
SUBJECT AND
SEMESTER
BOOK REQUIRED
OTHER INFORMATION
1. Title(s) currently used
Title Author Publisher Price
2. Names and Address of the famous Textbook booksellers near you.
3. Are you interested in writing books? If yes? What Course and what University
Signature of HoD
Seal of Department
Name:
E-mail ID:
Contact No:
Kindly note the following:
Please send us the proforma completely filled and don’t forget to attach your visiting card for prompt action.
We would be unable to accept any proformas by email. Only forms sent by post would be accepted. Please use this form,
and send to our Office
Name of the Institution
Name of the Principal
Address
City :
District :
State :
Pin :
Email
Web:
Phone No.