JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Information of Blood Group (रक्त समूह की जानकारी)
Citizen Registration Form (नागरिक पंजीयन प्रपत्र)
* Indicates required question
Full Name (पूरा नाम)
*
Your answer
Father / Husband Name (पिता / पति का नाम)
Your answer
Age (आयु)
*
Your answer
Gender (लिंग)
*
Male (पुरुष)
Female (महिला)
Transgender (ट्रांसजेंडर)
Email
Your answer
Address (पता)
*
Your answer
Block (विकासखंड)
*
Choose
Jashpur (जशपुर)
Manora (मनोरा)
Duldula (दुलदुला)
Kunkuri (कुनकुरी)
Bagicha (बगीचा)
Farsabahar (फरसाबहार)
Kansabel (कांसाबेल)
Pathalgaon (पत्थलगांव)
Mobile Number (मोबाइल नंबर)
*
Your answer
Alternate Number (अन्य मोबाइल नंबर)
Your answer
Blood Group (रक्त समूह)
*
Choose
A+
A-
B+
B-
AB+
AB-
O+
O-
OH+
OH-
Willing to donate blood (क्या आप रक्त दान के लिए सहमत है?)
*
Yes (हाँ)
No (नहीं)
Maybe (शायद)
Did you ever donate blood? (क्या आपने कभी रक्त दान किया है?)
*
Yes
No
If yes than how many times? (यदि हाँ तो कितनी बार?)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
