Franchise / Center Details

Please Enter Franchise Name
Please Enter Franchise Owner First Name
Please Enter Franchise Owner Last Name
Please Enter Course Instructor First Name
Please Enter Course Instructor Last Name
Please Enter Spouse First Name
Please Enter Spouse Last Name

Gender

Please Select Gender

Date Of Birth

Please Enter Date Of Birth

Residential address

State

Please Select State

City

Please Select City
Please Enter Taluka/tahsil
Please Enter Address1
Please Enter Address2
Please Enter Pin Code
Please Mobile Number

Franchise/ Center Address

Same as residence address

State

Please Select state

City

Please Enter Taluka/tahsil
Please Enter Taluka/tahsil
Please Enter Address Line 1
Please Enter Address Line 2
Please Enter Pin code

User Information

Please Enter EmailID
Please Enter Username
Please Enter Password

Upload Photo

image should be jpg,jpeg,& png format only

Please Upload Photo

Aadhar Card [PDF or JPEG]

Please select aadhar file

Pancard [PDF or JPEG] (optional)

Other Doc [PDF or JPEG] (optional)


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