Emitra Registration

Personal information

Date of Registration

Name

Mobile

Email

Date of Birth

Age

State

City

Block

Address

Alternate contact number

SSO_ID

Type of Location

UrbanRural

Gender

Nationality

Father/Husband Name

Aadhaar Number

Type

Pan Number

Type of Kiosk

Education Qualification

Type of Applicant

IndividualCompany

Name of Company/Organisation/Firm

GST Number

Address Of Kiosk

Kiosk Name

Street & Village/City Name

Nearby Police Thana

Panchayat Samiti(Rural)

Gram Panchayat(Rural)

Village(Rural)

Pin Code

Muncipal Town(Urban)

Ward No.(Urban)

Bank Information

Account Holder Name

Account Number

Bank Name

Branch Name

Bank Address

IFSC Code

Verfication

User Photo *

No file chosen

Signature *

No file chosen

Aadhar Card *

No file chosen

Pan Card *

No file chosen

Police Verification Available *

No file chosen

10th Marksheet Available *

No file chosen

Bank Detail or Cancel Check *

No file chosen

Rent Agreement

No file chosen

Jan Aadhar Card Upload *

No file chosen

Center Photo

No file chosen

Date Of Birth Document *

No file chosen

Infrastructure(PC,internet,etc Y/N)YesNo

VC Setup Y/NYesNo