Registration Form

Beneficiary Name:

Father's Name:

Mother's Name:

Date of Birth:

Gender:
MaleFemale
Mobile Number:

Email:

Identification Mark:

Category:
GeneralSCSTOBCOther
Blood Group:
A+A-B+B-O+O-AB+AB-
Marital Status:
MarriedUnmarried
Complete Address:

Educational Qualification:

Aadhaar Number:

Bank Name:

Bank Branch:

Account Number:

IFS Code:

Annual Income of Family:

Type of Dissability:

Percentage of Dissability:

Upload Passport Size Photo:
Upload Age Proof:
Upload Aadhaar:
Upload Passbook:
Upload Income Certificate Issued by Tehsildar/Competent Authority:
Upload Disability Certificate:
Upload Beneficiary Signature/Thumbmark: