Registration Form
Personal Details
Name of the Applicant*
Designation of the Applicant*
Date of Birth *
Aadhaar Number *
ID Proof (PAN/Ration Card/Voter ID/Driving Licence)*
PAN Card*
Ration Card*
Voter ID*
Driving Licence*
Address for Communication
State*
District*
Taluk*
Village / Town/ City*
Street 1*
Street 2
Door Number/ Plot Number*
Pincode*
District*
Taluk*
Village / Town/ City*
Street*
Door Number/ Plot Number*
Pincode*
Contact Details
STD code
Telephone number
Mobile Number (Employer / Proprietor / Owner)*


Please verify your mobile no.
E-mail Address (Username)*


Please verify your email address.
Documents to be uploaded
PAN / Ration Card / Voter ID / Driving License*
(Maximum file size should not exceed 1 MB.File should be pdf,jpeg format)
Upload filefile_upload
Aadhaar Card
(Maximum file size should not exceed 1 MB.File should be pdf,jpeg format)
Upload filefile_upload
Security Details
Password*
Password must meet the following requirements:
  • At least one letter
  • At least one Capital letter
  • At least one number
  • Be at least 8 characters
  • At least one special character
Retype Password*

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