SanjhiSakhi Registration Form

Registration Form

All fields are required*
Read and follow the instructions carefully prior to submitting your application. (Include link to instructions here).
I. Personal Data:

Tell us about yourself
Full Name

First NameMiddle NameLast Name
E-mail :
Where the confirmation will be send to
Mobile No. :

Area CodePhone Number
Birthdate:

MonthDayYear
Home Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Address Proof :

Upload a File

Cancelof
(Voter id/Aadhar card/Passport/Driving license)
Family Income
Income proof

Upload a File

Cancelof
Employment Status:

EmployedUnemployed
House:

OwnRented
No. of family members:
Thumb Impression

Upload a File

Cancelof
Family photo

Upload a File

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Involved in any police cases

YesNo
Any family member in jail

YesNo

V. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Read and Understand the instructions.

Yes, I have
E-Signature:

Registration Form