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Head of Family ( मुख्या का नाम ) :
Date of Birth ( जन्म की तारीख ) :
Gotra ( गोत्र ) :
Gotra
Airan
Bansal
Bindal
Bhandal
Dharan
Garg
Goyal
Goyan
Jindal
Kansal
Kuchhal
Madhukul
Mangal
Mittal
Nangal
Singhal
Tayal
Tingal
Education ( शिक्षा ) :
Father / Husband ( पिता/पति ) :
Native State ( मूल राज्य ) :
Native State
Haryana
Rajasthan
Other
Parental Village ( पैतृक गांव ) :
Mohalla ( मोहल्ला ) :
Select Mohalla
Ashoka Ratan / VIP State
Avanti Vihar
Bhatagaon
Choubey Colony
Civil Line / Raja Talab
Devendra Nagar
Fafadih
Geetanjali Nagar
Gudiyari
Kachna - vidhansabha
Kota
Mowa Kapa
Purani Basti
Ram Sagar Para
Sadar Bazar
Samta Colony
Shankar Nagar
Shailendra Nagar
Santoshi Nagar
Tatibandh
Home Address (घर का पता) :
Mobile No ( मोबाइल ) :
Email ( ईमेल ) :
Occupations ( व्यवसाय ) :
Select Occupations
Business
Profession
Govt. Employee
Others
Occupations Detail ( व्यवसाय विवरण ) :
Business Address ( व्यावसायिक पता ) :
Blood Group ( ब्लड ग्रुप ) :
Select Blood Group
A+
A-
B+
B-
AB+
AB-
O+
O-
In case of emergency ,
Do you want to donate the blood ?
Yes
No
पारिवारिक विवरण ( 18 वर्ष से अधिक महिला एवं पुरुष )
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