Registration

Center Details

Center Name *

( To enter your proper registration center name )

Address *

City *

Pin Code*

Country *

State *

Distict *

Taluka *

Phone

Mobile *

Email *

Password *

Confirm*

Co-ordinator Details

Full Name *

Date Of Birth *

Email *

Phone

Mobile *

Parmanat Address *

City *

Upload

Photo Proof ID *

( Size of file should be less than 121 kb (prefer Dimensions 340 x 460 pixels) )

Photo *

( Size of file should be between 20kb–50kb(prefer Dimensions 200 x 230 pixels) )

Sign *

( Size of file should be between 10kb–20kb(prefer Dimensions 140 x 60 pixels))

Shop Act / NOC (Grampanchayat) *

( Size of file should be less than 121kb (prefer Dimensions 340 x 460 pixels))