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1.Dept. /Organization (Details)

Organization Name*:
Department/Ministry Name*:
Organization Address *:
Pin Code*:
Name (contact Person)*:
Landline Phone(with STD)*:
Mobile (contact Person):
Email*:

2. Web site/Application developed by:

Dept./Organization Name*:
Dept./Organization Address *:
Pin Code*:
Name (contact Person)*:
Landline Phone(with STD)*:
Mobile (contact Person):
Email*:

3. Web site /application is security
audited and certified as fit for hosting
YES/NO
(If Yes, Please attach the audit certificate)
4.Auditor Details( if security audited
and certified as fit):

Organization Address:
Pin Code:
Staging URL Where Audited*:
Auditor Name*:
Contact Phone no*:
Email*:
Certificate Issued Date *:

5. URL Desired.*:

Aliases if Any:

6. Main /Default page name*: (Example:welcome.html/index.html/default.html)
7. Tile of the Website*:
8. VPN/FTP Required on Production*:
If required, specify client IPs.
Yes No

Web Site/Application Hosting Registration Form
Registration Reference No (to be filled by Data Centre):...
(Please send the form duly filled to HOD, Date Center, 1
st
floor, A Block,
BRKR Bhavan, Tank bund Road, Hyderabad-500 063)

All (*) Mark fields are Mandatory
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Last Update: 01/06/2013 Page 2 of 4



9. Ownership Details *:
Apex Bodies Central Govt State Govt
Other, Specify:..
10.Operating System*:
Windows Linux
OS Version:
11.Web Server* :
IIS Apache Tomcat Apache

Web Server Version:
12. Interactive Components (frontend):
Classic ASP DOTNET JSP PHP

Version:
13. Database Support needed(backend):
MS SQL MySQL PostgreSql Oracle

Version:
14.Web Content Management System:
Ajax Joomla Drupal

Version:
15. Web site Type*:
Static Dynamic
16. Development Base*:
NIC Developed NIC Coordinated Third Party

17. Site is multilingual*:
YES/NO

If Yes, Mention the language(s)
18. Audio/Video components*:
YES/NO
(If Yes, Please specify)
19.File(s) Uploading is there(Y/N) *:
( If yes, provide details)
a. Type of file(s) :
b. Total Files Size (in MB) *:
YES/NO

Current :: Yearly Incremental::
20. Size of the website (in MB):
21.Size of Database (in MB): Current :: Yearly Incremental::
22. SAN Storage Required(Y/N) *:

Yes/No
(If yes, enclose Storage Request Form)
23. Nature of Web Site /Application*:
G2G G2C C2G

24. Nature of Site *:
Permanent Event Based
25. Mode of Service*:
If free, enclose Annexure A.
If paid, payment details.
Free Paid



Signature and Seal Signature
(HOD, User Department) (HOD of Application Division, NIC)
Name: Name:
Date: Date:


Signature of HOD, Signature of DDG&SIO, NIC
Data Centre with Date Date:
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Last Update: 01/06/2013 Page 3 of 4


Annexure A

Web Site/Application Hosting Registration Form
To be filled by Head of the Organisation



THIS IS TO CERTIFY THAT THIS (name of the organisation)..
UNDER THE DEPARTMENT OF ,
MINISTRY OF GOVERNMENT OF
.. IS FULLY FUNDED BY THE
GOVERNMENT AND NO REVENUE IS GENERATED INTERNALLY IN THE
ORGANISATION.

THEREFORE YOU ARE REQUESTED TO WAIVE THE WEBSITE HOSTING
CHARGES, IF ANY.



Signature and Seal
(HOD, User Department)
Name
Date: ....

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Last Update: 01/06/2013 Page 4 of 4

Web Site/Application Hosting Registration Form


I. Payment Details (For paid Projects)

Amount:

Bank:
Cheque No /
Draft No

City:

Date: Hosting charges for no of years




Signature
(HOD of Application Division, NIC)
Name:
Date:


II. Hosting Details:
(To be filled by Data Centre)

Sr No
Activity Name of the Officer with Sign and Date
1
Appl Content & DB
Backup Received

2 Hosted On Stage Server
3 ASMS Entry (in case of
outsiders)

4 Internal Audit Request Sent
5 DNS Registration
6 DNS Entry Request Mail
Sent

7 Audit Clearance Received
8 Hosted on Production
Web Server IP:
DB Serve IP:





Date: Signature of HOD, Data Centre