(In company letterhead)

Annexure 1 (clause 4)

APPLICATION FORM FOR NEWS WEB CHANNEL SEEKING EMPANELMENT

1. Name of the News Web Channel Name of Youtube/Facebook channel

(In block letters):

2. Place of functioning: Where is your office?

3. a. Place of broadcast/telecast and Repeat office address

periodicity:

b. Report of Facebook and

YouTube analytic: Attache screenshots below for 6 months

4. Percentage of Punjab based news in % of last 6 months

covered:

5. If affiliated with newspaper or TV If applicable, else blank

channels (Please specify name):

6. Permanent address in full (Copy of Write address, should match rent

residence proof be attached): agreement

7. Present address at place of work Write address, should match rent

(in full) agreement

8. Telephone Number of Office Phone number

Residence

9. Mobile Number and Email address mob number email address

Signature of Applicant
(IN BANK LETTERHEAD)
SOLVENCY CERTIFICATE:

This is to state that NAME OF THE CUSTOMER having Redg. Office/Head at

ADDRESS OF THE OFFICE/HEAD are a customer of our branch since JOINING
DATE. The conduct of account of firm has been satisfactory and is solvent as on date.

It is clarified that this certificate is issued without any risk and responsibility on the part
of NAME OF THE BANK or any of its officials in any respect whatsoever, more
particularly either as guarantor or otherwise. This certificate must be taken as a private
& confidential report given by the Bank without prejudice and on the express condition
that NAME OF THE BANK & its officials are held free by you from any liability in
connection with it.

This certificate is issued for the above-mentioned specific purpose, and at the specific
request of our customer NAME OF THE CUSTOMER. This certificate is Valid for three
months from the date of issue.

Bank account details

Account number -
IFC code -
Branch -
Account holder name -
Bank name -
 (In company letterhead)
Date: Date of submission

To,

Director
Directorate of Information and Public Relations
Punjab Civil Secretariat,
Near Chandigarh Club, Sector 1,
Chandigarh, 160001

Subject: Application for Empanelment of Web channel [ Fill your channel URL] with DIPR
Punjab (Directorate of Information and Public Relations) for publicity of Punjab Government
through News Web Channel Policy

Respected Sir,

We would like to apply for the empanelment of our [Fill your channel URL] with DIPR PUNJAB.
The following documents are being submitted for the same.

1. Register Companies/Firm/Individuals

2. Latest Bank Solvency certification

3. Self-certified from channel head regarding minimum period of 1 year on same name

4. Facebook and YouTube analytic report for the period of six months (attested by
MD/CEO)

5. Upload at least 50 videos or sound bite or news items (Hyperlink in excel) with in the
period of one month or during the period of months

6. Rent deed or ownership address have an office in Punjab or Chandigarh

7. Verified Facebook page and YouTube channel providing the detail whom detail is
registered (Email copy)

8. Last one year IT return of the firm

9. Certificate from the channel head that the information submitted for the empanelment is
correct

10. The firm/company/Organisation/Individuals must possess a valid GSTIN and Pan No.
Date: Date of submission

I Name of head of channel head of channel all the information submitted for
empanelment is correct and best of my knowledge and believe.

I Name the head of the channel and confirm that this channel has been continuously
operating for more than one year.

I Name of head of channel head of channel Confirm that this channel has not been
debarred or black listed by State Government or Government of India

THIS IS TO CERTIFY THAT THE INFORMATION SUBMITTED BY (Fill in your

Company Name and YT/FB URL) IS CORRECT AND WE WILL ABIDE BY THE
TERMS AND CONDITIONS OF DIRECTORATE OF INFORMATION & PUBLICITY

I shall abide by the decision of the Competent Authority regarding

empanelment, rates, telecast etc.

(DIPR PUNJAB) AS WELL AS THE DECISION OF DIPR PUNJAB REGARDING THEIR

EMPANELMENT. IN CASE, THE INFORMATION SUBMITTED BY THE WEB
CHANNEL IS FOUND TO BE FALSE / INCORRECT IN ANY MANNER, THE WEB
CHANNEL CAN BE SUSPENDED AND / OR DEBARRED FROM EMPANELMENTS.

Screenshot of YouTube page where URL, verified badge & subscribers is mentioned
Example:-
https://drive.google.com/file/d/1IvVpvxtMeS6ieKXAhWodbl308IbpMCRW/view?usp=
drivesdk

Name of head of channel

Name of the firm/company/organisation

Head Office: -
Office Address

Mobile Number:- Contact number

E-mail : Email address

Date: Date of submission

I Name of the firm/company/organisation sharing all the followers list of the all social
media accounts.

Sr Name of Subscribers
Platform URL
no channel
name

Name of the platform

Youtube
Name of Youtube Channel Number of subscribers
1 xxK
channel URL

Facebook
Name of Name of the platform Number of subscribers
2 Facebook Channel xxK
channel
URL

Instagram
Name of Name of the platform Number of subscribers
3 Instagram Channel xxK
channel
URL

Name of head of channel

Name of the firm/company/organisation

Head Office: -
Office Address

Mobile Number:- Contact number

E-mail : Email address

Upload at least 50 videos or sound bite or news items (Hyperlink in excel) with in the period of
one month or during the period of months

Name of News Web Channel - Previous Month

Sr. No. Title Hyperlink Date

1 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

2 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

. . . .
. . .
.
. . .
.

Till 50 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

Name of News Web Channel - Previous Previous Month

Sr. No. Title Hyperlink Date

1 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

2 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

. . . .
. . .
.
. . .
.

Till 50 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

Name of News Web Channel - Previous Previous Previous Month

Sr. No. Title Hyperlink Date

 1 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO
VIDEO VIDEO

2 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

. . . .
. . .
.
. . .
.

Till 50 TITLE OF THE LINK/URL OF THE DATE OF THE VIDEO

VIDEO VIDEO

How to download YouTube Analytic data: -

https://youtu.be/L93yB11cJWE?si=zLH0XeXMJxPBpx9W

How to download Facebook Analytic data: -

https://youtu.be/UYAId7Fc8xM?si=Jhb4OE2yv3H0ePUo

How to verify & Indexing Facebook:-

https://youtu.be/xq0jM441V6k?si=XVaUJxzJ8_BjlLnW