|
| |
|
|
* fields are mandatory |
|
| |
Name of Applicant * |
: |
|
| |
Type of Applicant |
: |
|
| |
Address of kiosk * |
: |
|
| |
Tehsil / Block |
: |
|
| |
District * |
: |
|
| |
State * |
: |
|
| |
Pin code * |
: |
|
| |
Email * |
: |
|
| |
Permanent Residence address:- * |
: |
|
| |
Contact No. Office * |
: |
|
| |
Mobile * |
: |
|
| |
Size of Shop where emitra kiosk will Run minimum 10*10=100Sqft * |
: |
|
|
| |
|
|
|
|
|
|
|