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
AHMEDABAD
AMRELI
ANAND
ARAVALLI
BANASKANTHA
BHARUCH
BHAVNAGAR
BOTAD
CHHOTA UDAIPUR
DAHOD
DANG
DEVBHOOMI DWARKA
GANDHINAGAR
GIR SOMNATH
JAMNAGAR
JUNAGADH
KUTCH
KHEDA
MAHISAGAR
MEHSANA
MORBI
NARMADA
NAVSARI
PANCHMAHAL
PATAN
PORBANDAR
RAJKOT
SABARKANTHA
SURAT
SURENDRANAGAR
TAPI
VADODARA
VALSAD
Tehsil / तहसील *
Your answer
PIN No. / पिनकोड नंबर *
Your answer
How would you like to receive payment? / आप भुगतान कैसे प्राप्त करना चाहेंगे?
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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
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