Application for Jan Sewa Kendra(CSC)
*Applicant Type :  Previous SCA Name : 
Previous VLE ID:  *Type of CSC Location : 
* State :  *District : 
*Tehsil/Sub District :  * Block:  
*Town:   * Gram Panchayat:  
*Ward:   * Village :  
Mohalla:   Mohalla No :  
* Ward No:   *Village Code :  
*Location:  *Pin Code: 
Applicant (VLE) Information
*Applicant(VLE)Name :  *Father Name : 
*Mother Name :  *Gender : 
*Marital Status :   
*Date of Birth :  *Mobile No: 
Alternate Mobile No:  Land Line (with STD Code): 
* E-Mail ID :  *Permanent Address : 
Pan No : Voter ID No :
AADHAR Card No : Other ID ( For Address Proof ) :
: *Education Qualification : 
Professional Qualification : *Computer Knowledge : 
* Present Business :  
Available Infrastructure
* Laptop/desktop Qty : * MFP / Printer Qty :
* Scanner & Digital Camera Qty : * UPS/Power Backup Qty :
* Genset (KVA) Qty :
Documents Attachment Required (JPG/PNG of original documents, Size: 50KB to 200KB)
* Latest Passport size Photo : PAN Card : 
Voter ID :  AADHAR Card : 
:  Other Address Proof :
Declaration
I hereby declare that all information given above are correct to the best of my knowledge & belief.
Note:
(1). Please enter valid Mobile Number. All OTP and password will be communicated on it.
(2). Please enter valid E-mail ID for further communication.