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आपका नाम (Name)*

पिता/पति का नाम (Father's Name/Husband Name)*

आपका कार्य (Present Occupation)* Select AgricultureAccountantAdvocateAuthorArmy ActorAdministrative ManagerArtitectBank EmployeeBook ShopkeeperStudentsTeacherProfessorLecturerPrivate JobSoftware Engineer DoctorMobile ShopGold ShowroomShoe Showroom Departmental StoreKariyana StoreRailway EmployeeAasha WorkerMLM LeaderPhotostate ShopClothe ShowroomComputer CenterCoaching CenterComputer TeacherComputer LATeachar GuestGBTB EdITIPoli TechnicalUn-EmploymentUn-EmployeeOwn-BusinessElectronic ShopCSC-HaryanaPrincipalPolitical LeaderAir ForceNavyRestorantITPhotograferMedical ShopPolice ReporterNurseSecurity GaurdForeignerFlex Printers Tailor ShopFurniture ShopBeauty Parlour SalonComputer OperatorGarments ReadymatePrivate SchoolHaryana Govt. EmployeeCarpenter ShopSweat HouseGeneral InsuraceInsuranceCateringNetworkerHarbel ProductTravel AgenciesMoney TransferTransport AgencyHardware StoreTent HouseConfestionoryBakeryNGOCar GaloryMoter Cycle Repair

मोबाइल नम्बर (Mobile Number)*

ईमेल पता (Email)

राज्य (State)* Select HaryanaPunjab

जिला (District)* Select District first

तहसील / शहर (Tehsil/Town)* Select Tehsil first

पिनकोड (Pincode)*

पता (Address with Landmark)*

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