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Applicant Registration Form


Applicant Details
Salutation* Full Name*
User Name( User Name can have Alphabet, Numbers, _ and - Only)* Password*
Confirm Password* Date of Birth*
Age (Years) Mobile Number*
Email ID* ULB Name
( If Applicant residing in an ULB area within West Bengal)
District Address*
State Country
Post Office PIN *
Police Station Aadhaar Number
PAN *
PAN Document
(Please upload only JPEG,JPG,PNG or PDF formats of 500KB or less) *
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Photo ID Type
Photo ID No
Photo ID Document
(Please upload only JPEG,JPG,PNG or PDF formats of 500KB or less)
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Captcha *