SUBMIT APPLICATION      
 
NOTE: Please Enter Complete Application Details NOT Application Brief/Gist In Application Details Box.    
   Application Nature ->      NOTE: Fields marked as # are mandatory  
Application Nature #                               
   Submit Application to ->
Department #  
Application Type #  
District #  
Office #  
   Application Details ->  
Application Details #










Application may also be entered using any Unicode compliant Hindi font
 
Old Online Application Number     ( If to mention )
   Location Of Grievance ->  
State #
District #  
Select Area Type #  
Select Block/Ward #  
Select Panchayat #  
Select Village #  
Constituency #  
   Applicant's Details ->  
Applicant Name #      #  
Applicant Category #  
Permanent Address #  
         
    Correspondence Address same as Permanent address
Correspondence Address #    
Telephone Number with STD code     eg. 01772625216
   Please Mention Mobile Number or E-mail ID  
Mobile No. (don't prefix 0 or +91)    
e-mail Address       
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