Registration Form

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Applicant Registration Form

Applicant Address

Name of Applicant
(as per SSC Certificate, it is necessary for applicants for supervisor,WireMen)

SurName*

Name*

Relation*

SurName*

Name*

Date of Birth* Note : Age shall be min.18 and max 80 at the time of registration

Address Proof Type*

Upload copy of Address Proof* (.pdf) (upto 200kb) Clear

Email*

Enter Password*

Permanent Address (as per proof)

Address Line 1*

Address Line 2

Address Line 3

District*

ManDal/Town*

Village*

Pin Code*

Communication Address (as per proof) Same as above

Address Line 1*

Address Line 2

Address Line 3

District*

ManDal/Town*

Village*

Pin Code*

Alternate Email*

Mobile No*

Registration for* Fresh Renewal

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