Paschim Banga Society for Skill Development

Salutation*

First Name*

Middle Name

Last Name*

Gender*

Aadhaar/Voter/Driving License No.

PAN No*

D.O.B*

House / Flat / Building / Plot No*

Street Name

Post Office

State*

District*

Block / Municipality

Pincode*

Police Station

Landline No

Mobile No*

Email*

Organization Name*

House / Flat / Building / Plot No

Post Office

District*

Block / Municipality

Pincode*

Landline No

Mobile No*

Email*

Qualification*

Sector of Expertise*

Experience*

Account Number*

Bank Name*

Branch Name*

IFSC Code*

Account holders full name*

Declaration : I do hereby declare that the above information is true to my knowledge. I do have an Android Phone.

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