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MINISTRY OF WOMEN & CHILD DEVELOPMENT Government of India

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Proforma for Empanelment as Resource Person having expertise on the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013

Name *

Age *

Gender *

Contact Details*

Mobile *

Email *

Pincode *

Address *

Educational Qualifications *

S.No.	Name of the Degree	Year	University/College
(i)
(ii)
(iii)

Presently Working At *

(i) Name of the Organisation *

(ii) Address of the Organisation *

(iii) Designation *

(vi) Work Profile (Enlarge the box, if required) *

Experience *

S.No.	Name of the Institute where training/ workshop was provided	Subject of Training/ workshop	Period of Training/ workshop	Your role in the training/ workshop (trainer, designer, organiser etc.)
(i)
(ii)
(iii)

List of Publications *

(i)	(ii)	(iii)

Language Proficiency *

Kindly provide names of two persons familiar with your work and qualifications *

S.No.	Name	Complete Address (with telephone and email address)	Occupation
(i)
(ii)

Declaration

Undertaking: I declare that the particulars furnished above are true and complete to the best of my knowledge.

Date *

Place *

Upload Signature *

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(*) Mandatory fields.