| Name of Department | |
| Name of Format | |
| Language | English/ Marathi/ Hindi / --------------- |
| Name of Department (for non English formats) | |
| Name of Format (for non English formats) | |
| Frequency of Collection | Daily, Weekly, Fortnightly, Monthly, Bimonthly, Quarterly, Half yearly, Yearly, Once, Latest |
| Reporting period | upto ------ days from due date |
| Password for guest user | Keep blank password No guest user |
| Contact Person | |
| Office Address | |
| Telephone No | |
| Report collection from (tick) | Division /District /Taluka /Village Other ------------- /--------------- /--------------- /------------------ (Attach hierarchy) |
| Head of Department | |
| Signature and Seal of Head of Department | |
| Department ID | |
| Format ID | |
| Administrator Password | |
| Operator Password | |
| Created by | |