CHOUDHARY COMPUTERS

Kisok Owner Detials

Kisok Owner Name

Kisok Owner e-Mail

Mobile Primary

Mobile Secondary

PAN Number

Aadhaar Number

Permanent Address (Line 1)

Permanent Address (Line 2)

State

Please select a valid state.

City

Please select a valid state.

Zip

Please provide a valid zip.

Kisok Center Detials

Kisok Center Name (English)

Kisok Center Name (Hindi)

Kisok Center Contatct Person Name

Contatct Person Mobile

Kiosk Owner Personal SSO ID

Kiosk eMail ID

Police Station (Thana)

Ward No

Kiosk Address

State

Please select a valid state.

City

Please select a valid state.

Zip

Please provide a valid zip.

Kisok Bank Details

Bank a/c Number

Bank Name

Branch Name

Account Holder Name

Kiosk Location Level

Please define the level of Kiosk if the kiosk having more than one level, mention all levles:-

	Levels	Details (Name)	Private Location	IT Center (Rajasthan Sampark/ Government Building)
	District (Head Quarter)
	Tehsil
	Panchyat Samiti/ Block
	Gram Panchayat
	Village

Photo and Signature

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