APPLICATION FOR ACCREDITATION /REPORTING FACILITIES OF PRESS CORRESPONDENTS TO THE GOVERNMENT OF KERALA AT DISTRICT HEA DQUARTERS Form The Managing Editor/ The General Manager/ The Managing Director/ The Proprietor, ............. (Address To The Director of Public Relations, Government of Kerala, Thiruvananthapuram (Through the District information officer) ............. Sir, (1) (2) The correspondent of.............(name of newspaper or news agency ) whose name and particulars are appended herewith may kindly be granted Accreditation/ Reporting Facilities to the Government of Kerala and allowed the usual facilities : Name of newspaper/news agency : (in block letters) Address : (3) Frequeny of publication (in case of newspaper) Or method of distribution of services, centre of newspaper catered for (in case of news agencies) : (4) Audited circulation (copy of certificate enclosed) in case of newspaper : (5) The Class in which the newspaper or agency is placed : (6) Special features of he news agency : (7) whether accredited at the headquarters of the state : (8) Date of commencement of publication/service : (9) Particulars of correspondent for : whom accreditation sought (a) Name in full : (b) Father's name : (c) Age : (d) Permanent residential address : (e) Present residential address : (f) Experience in Journalism : (i) Name of newspaper/news agency served : (ii) Position held and their duration : (iii) Duration of service in the newspaper, newspaper or agency seeking accreditation : (iv) Will he be employed wholetime as an accredited : (v) correspondent on behalf of OR Will he work partly for And partly for other newspapers? If so specify : (g) Educational Qualifications : (h) Details of accreditation cards (if any issued by the Government of India or State Governmetn previously held, date of issue and reasons for surrender or cancellation : (i) Telephone number of representative : (10) I Certified that Shri......... .........is a working Journalist and wholetime correspondent of the..........and his present salary is Rs......... In the scale of Rs......... With allowance of Rs......... (11) We agree to abide by the Accrediation Rules. Station : Signature of General Manager/ Date : Managing Editor/Managing Director/Proprietor Signature of correspondent.
