Registration Form
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Fill in the details and click on Submit to proceed.Use Mouse to move between fields for entry of data instead of using Tab Key.
Fields marked with*are mandatory.

Kindly enter Pincode registered in Aadhaar Card.

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*Personal Details
*Name of the Applicant /आवेदक का नाम
*Applicant's Father name /पिता का नाम
*Applicant's Mother name /माता का नाम
*Other Personal Details
 
*Gender/लिंग    Male/पुरुष
  Female/स्त्री
  Transgender/ट्रांसजेंडर

*Date of Birth/जन्मतिथि


*Mobile No/मोबाइल नंबर *Email ID/ईमेल आईडी
*10th Roll Number/रोल नंबर     
*12th / Diploma (Roll Number/रोल नंबर)     
*Do you have Polytechnic Diploma Yes No

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Version 14.03.01