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APPLICATION FOR LICENSEE ACCOMMODATION

(Please fill in English. Applicants should be 18 yrs of age and above. Information in all sections is mandatory. The application form shall not be accepted without complete information.)

APPLICANT INFORMATION

Name of the Applicant ^*

Valid name is required.

Applicant Date of Birth ^*

Applicant date of birth is required.

Marital Status^*

Please select a food type from dropdown.

Applicant Mobile Number ^*

Applicant Mobile Number is required.

Applicant Alternative Mobile Number ^*

Your Applicant Alternate Mobile Number is required.

Applicant E-Mail Adress ^*

Please enter a valid email address.

food that you eat^*

Please select a food type from dropdown.

APPLICANT ADDRESS INFORMATION

(Please provide your complete address with pin code and attach address prof along with this application form. Your application form will not be accepted without the address proof.)

Postal Address ^*

Please enter a Address Line one...

Postal Address (Optional)

Please enter a Address Line two...

Locality (Optional)

Please enter a Locality...

City/Town/Village ^*

Please enter a City/Town/Village...

Post Office ^*

Please enter a Post Office...

Police Station ^*

Please enter a Police Station...

District ^*

Please enter a District...

Postal Code ^*

Please enter a Postal Code...

State ^*

Please select a valid State from dropdown.

Land Mark (Optional)

Please enter a Land Mark...

APPLICANT NATIONALITY IDENTIFICATION DETAIL

(Please provide attested xorex copy of any two seleced documents.)

Select any one Document ^*

Please select any one Document.

Select any one Document ^*

Please select any one Document.

PROFESSIONAL INFORMATION

(Please provide an attested xerox copy of the related documents.)

Select Occupation ^*

Please select a valid Occupation.

Date of Occupancy ^*

Applicant date of birth is required.

Estimated Period of Occupancy ^*

Please enter Estimated Period of Occupancy...

PARENT INFORMATION

(Please provide attested xerox copy of the related documents)

Father Name ^*

Please enter a Father name...

Mother Name ^*

Please enter a Mother Name...

Occupation (Father) ^*

Please enter a Father Occupation...

Occupation (Mother) ^*

Please enter a Mother Occupation...

Mobile No. (Father) ^*

Please enter a Father Mobile number...

Mobile No. (Mother) ^*

Please enter a Mother Mobile number...

Address ^*

Please enter a Address...

LOCAL GUARDIAN INFORMATION

(Please provide your complete address with pin code and attach address proof)

Name of Guardian ^*

Please enter a Name of Guardian...

Relationship with Guardian^*

Please enter a Relation...

Guardian Contact Number^*

Please enter a Contact Number...

Guardian Address ^*

Please enter a Guardian Address...

I do hereby declare that the statements made above are true and correct and the documents furnished along with the form are genuine to the best of my knowledge and belief. In case any information /documents are subsequently detached to be fake or false, my application / admission shall be treated as cancelled.