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Applicant CSP/ Information

Name of Applicant/CSP *

Gender *

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Female

Transgender

Father's Name/Spouse Name

DOB *

Category *

General

OBC

SC

ST

Highest Education Qualification

Institute Name *

Physically Handicapped *

Yes

No

Date of Passing *

Cource *

Name of Establishment *

User Id

Shop Name*

Bussines Location Address (Operational Area )

Location *

Area *

City *

District *

State *

Country *

Pin Code *

Tel No

Mobile No *

Email *

Proof of Address *

ID Number *

Bussines Information

Alternate Occupation Type *

Aadhaar Card Number *

PAN Number *

Oprating Time *

Corporate/Individual BC*

Provider *

Device Name *

Laptop

Hand Held

Connectivity Type *

Landline

Mobile

VSAT

Alternate Occupation Description

Banking Information

Bank *

A/c Type *

A/c No *

IFSC Code *

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