Register – जन गण मन उत्थान कार्य समिति

Account Details

Mobile Number

Password

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Password Strength

Profile Details

First Name (पहला नाम) *

Last Name (उपनाम)

E-mail Address

Referred By

Father's Name (पिता का नाम)/ Husband's Name (पति का नाम) *

Address (घर का पता)

Blood Group+ (रक्त समूह)

Aadhar Card Number (आधार कार्ड नंबर)

Date of Birth (जन्म की तारीख)

Education (शिक्षा)

Occupation (व्यवसाय)

Family disease history, if any (परिवार की बीमारी का इतिहास)

Social Service Experience? (सामाजिक सेवा का अनुभव ?)

Witness Name

Witness Aadhar Number

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Profile Picture

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Upload Passbook/Cancelled Cheque( पासबुक / रद्द चेक अपलोड करें)

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Upload Aadhar Card (आधार कार्ड अपलोड करें)

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