First Name^*

Middle Name^*

Grandfather Name

Grandfather City:

Last Name^*

Mother Name

Mother's Father Name

Mother's Father Last Name

Mother Father City

Birth Date

Blood Group Blood Group A+ve B+ve AB+ve O+ve A-ve B-ve AB-ve )O-ve

Mobile No^*

Alternate Mobile No

Full Address

Email

Status
Status Married Unmarried Divorce Widow

Marriage Anniversery Date (If Married)

Qualification
Qualification 10th 12th Graduate Post Graduate Others

Other (Field) is Required Otherwise type NA

Gotra
Gotra Kagranu - Kamakshi Devi Bhatsanu - Bhandodri Devi Kalyaanu - Kalyani Devi Nandola - Naishu Devi Narsanu - Narsinh Devi Vasiyanu - Vishveshwari Devi Nannu - Nityanandi Devi Mervanu - Mahipalini Devi Salisanu - Sureshvari Devi Gaudana - Gunmay Devi Nadiyanu - Nareshwari Devi Savlanu - Sakri Devi

Occupation
Occupation Student Business Job Retired Housewife

Gender
Gender Male Female

Pin^*( 4 digit)

Confirm Pin^*(4 digit)

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