Registration

First Name*

Last Name

Fathers Name*

Mobile Number*

Caste *

Social Category*

Password*

Confirm Password*

State/UT of Origin*

District*

City / Landmark / Panchayat - Village

Pincode

Community*

State Specific Community

State/UT*

District*

City / Landmark / Panchayat - Village

Pincode

Upload Passport Size Photo
(Upload .jpg /.jpeg file only upto 100 KB)

Do you have Caste Certificate?*

Do you have DNT Certificate?*

Do you have Annual Income Certificate?*

Bank Type

Account Number

Confirm Account Number

Account Holder Name

Passbook First Page/ Cancelled Cheque Cheque
(Upload pdf/image file only upto 100KB)

Name:* Date of Birth:* Gender:*	IDProof:* ID Proof No:* Mobile No*:	Relationship: Father Name: Mother Name:	Marital: Literacy:	Livelihood: Income:	Avail Scheme Benefits: Free Coaching: Health Insurance: Livelihood: Housing:	Photo: (Upload .jpg /.jpeg file only upto 100KB) Consent Form: (Upload .pdf file only upto 100KB)

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