Citizen Registration Form


Citizen Details
Salutation Full Name*
User Name( User Name can have Alphabet, Numbers, _ and - Only)* Password*
Confirm Password* Date of Birth*
Age (Years) Mobile Number*
Email ID* ULB Name ( If Applicant residing in an ULB area within West Bengal)
District Address*
State Country
Post Office PIN *
Police Station Aadhaar Number
PAN * PAN Document (Please upload only JPEG,JPG,PNG or PDF formats of 500KB or less) *
Photo ID Type Photo ID No
Photo ID Document (Please upload only JPEG,JPG,PNG or PDF formats of 500KB or less)
Captcha *