Your Rank (if you are ex-defence) / आपका रंक (यदि आप पूर्व सैनिक हैं)
Your answer
Mobile Number (permanent mobile number only) / मोबाइल नंबर (स्थायी मोबाइल नंबर) *
Your answer
Is this a Smart phone? / क्या यह स्मार्ट फोन है? *
District / जिला *
Choose
AJMER
ALWAR
BANSWARA
BARAN
BARMER
BHARATPUR
BHILWARA
BIKANER
BUNDI
CHITTORGARH
CHURU
DAUSA
DHOLPUR
DUNGARPUR
HANUMANGARH
JAIPUR
JAISALMER
JALOR
JHALAWAR
JHUNJHUNU
JODHPUR
KARAULI
KOTA
NAGAUR
PALI
PRATAPGARH
RAJSAMAND
SAWAI MADHOPUR
SIKAR
SIROHI
GANGANAGAR
TONK
UDAIPUR
Tehsil / तहसील *
Your answer
PIN No. / पिनकोड नंबर *
Your answer
How would you like to receive payment? / आप भुगतान कैसे प्राप्त करना चाहेंगे?
Clear selection
Provide Bank details if you have selected Bank Account - (Account Holder Name, Bank Name, Place, Account No and IFSC Code) / यदि आपने बैंक खाता चुना है तो बैंक विवरण प्रदान करें - (बैंक का नाम, खाता संख्या, IFSC कोड)
Your answer
Postal Address (for receiving mail) Name, Father Name, Village, PO, Tehsil, Thana, Zila or pin code / डाक पता (मेल प्राप्त करने के लिए) *
Your answer
Is this your permanent Residence? / क्या यह आपका स्थायी निवास है *
Email (ईमेल पता)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of briskolive.com. Report Abuse