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
AGRA
ALIGARH
PRAYAGRAJ
AMBEDKAR NAGAR
AMETHI
AMROHA
AURAIYA
AZAMGARH
BADAUN
BAGPAT
BAHRAICH
BALLIA
BALRAMPUR
BANDA
BARABANKI
BAREILLY
BASTI
BIJNOR
BULANDSHAHR
CHANDAULI
CHITRAKOOT
DEORIA
ETAH
ETAWAH
FAIZABAD
FARRUKHABAD
FATEHPUR
FIROZABAD
GAUTAM BUDDHA NAGAR
GHAZIABAD
GHAZIPUR
GONDA
GORAKHPUR
HAMIRPUR
HAPUR
HARDOI
HATHRAS
JALAUN
JAUNPUR
JHANSI
KANNAUJ
KANPUR DEHAT
KANPUR NAGAR
KASGANJ
KAUSHAMBI
KUSHINAGAR
LAKHIMPUR KHERI
LALITPUR
LUCKNOW
MAHARAJGANJ
MAHOBA
MAINPURI
MATHURA
MAU
MEERUT
MIRZAPUR
MORADABAD
MUZAFFARNAGAR
PILIBHIT
PRATAPGARH
RAE BARELI
RAMPUR
SAHARANPUR
SAMBHAL
SANT KABIR NAGAR
SANT RAVIDAS NAGAR
SHAHAJANPUR
SHAMLI
SHRAVASTI
SIDDHARTHNAGAR
SITAPUR
SONBHADRA
SULTANPUR
UNNAO
VARANASI
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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