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Registration Form

242 Flats Pinjore-Kalka EWS Scheme

Whether owned any house in Haryana either in own name or in the name of spouse or any dependent including unmarried childern : *
Scheme Category*
Applicant Name : *

Father/Husband Name :*

Mother Name :*

Gender: *
DOB : *

Mobile Number: *
Email Id :

Station :
Sector :

Correspondence Address:

House/Flat/Door No. : *
 Name of the Street/Road : *
City/Village. : *
District *
State : *
PinCode:*

Permanent Address same as Correspondence address : *
Identity Proof : *
Application Fee : (Non Refundable)
Registration Fee :

Upload Photo and Signature:
Maximum size allowed is 50 KB
Applicant Photo :* (Latest Passport Size Photo With Date) Signature/Thumb Impression : * ( Maximum size allowed is 50 KB)

Create User Credential

User Id :*

(6-15 characters and should not contain any special symbol)
Password :*
Confirm Password : *

Declaration

I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief. In case any information given in this application proves to be false or incorrect, I shall be responsible for the consequences.

I hereby declare that I have read terms and conditions before applying.