7/3/2019 User Registration Page

User Registration for Form 'C'

03 Jul 2019 Wed 20:39:44 PM
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Individual Registration Help
nithars1991 User ID is case sensitive, minimum one alphabetic character and minimum one numeric character
User ID *
User ID Available
min 8 chars,use at least one special character
Password * ••••••••• (/ . [~ ! @ ' # $ % ^ & * ? _ ~ - , () ] + / )! "),number,lowercase,
uppercase letter
Confirm Password * •••••••••
If you forget your password we will identify you with this information
In case you forget password, we will identify
Security Question * What is the name of the hospital where you were born?
you by this
Your Answer * home
Name *
Gender * Select
Date of Birth *
Occupation*
Email ID * Email Id is Mandatory

Mobile * Mobile number is Mandatory

Phone Number
Nationality * INDIA
Individual House Details
Name *

Address *

State * Select
City/District * Select
Email ID :* Email Id is Mandatory

Mobile :* Mobile number is Mandatory

Phone Number :
Individual House Owner's Details
City/Dist.
Name * Address * State * Email-ID.* Phone No. Mobile *
*

Select Select

Mobile number is Mandatory

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Fields marked *
are Mandatory

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