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
PATNA
NALANDA
BHOJPUR
BUXAR
ROHTAS
KAIMUR
GAYA
JEHANABAD
ARAWAL
NAWADA
AURANGABAD
SARAN
SIWAN
GOPALGANJ
MUZAFFARPUR
MOTIHARI
W. CHAMPARAN
SITAMARHI
SHEOHAR
VAISHALI
DARBHANGA
MADHUBANI
SAMASTIPUR
MUNGER
BEGUSARAI
SHEKHAPURA
LAKHISARAI
JAMUI
KHAGARIA
BHAGALPUR
BANKA
SAHARSA
SUPAUL
MADHEPURA
PURNEA
KISHANGANJ
ARARIA
KATIHAR
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
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