@if( Session::has('success'))

× Success! You are registered successfully Proceed To Login @if( Session::has('lastUserId')) and Download Form @endif

@endif @if( Session::has('error'))

× Error! {{ Session::get('error') }}

@endif

Choose Proposer

Proposer :

Personal Information

Member Type: *

Residence Pincode *

Upload Profile (upload jpg,jpeg,png & less than 2MB only)

Salutation *

Surname *

First Name *

Father/Husband Name *

Mother's Name *

Primary Mobile No. * @if($errors->has('contact')) {{ $errors->first('contact')}} @endif

Secondary Mobile No.

Secondary Email

Date of Birth *

Gender *

Marital Status *

Marrage Date

Nearest Railway Station*

Direction *

Qualification :

Occupation :

Choose Correspondence Type: *
Residential Address:
Office Address:

Residential Address:

Flat No/Wing No/Room No: *

Building/Society Name/Landmark: *

City/State: *

Pincode: *

Office Address:

Flat No/Wing No/Room No: *

Building/Society Name/Landmark: *

City/State/Pincode: *

Pincode: *

Native Address:

Flat No/Wing No/Room No: *

Building/Society Name/Landmark: *

City/State: *

Pincode: *

Other Address:

Flat No/Wing No/Room No: *

Building/Society Name/Landmark: *

City/State: *

Pincode: *

Website (Optional):

Business Email (Optional)

Office Contact No (Optional)

Family Member (optional)
Details of existing mandal's member in your family if anyone.

Khanp: *

UpKhanp:

Residential Proof : * (upload jpg,jpeg,png,pdf & less than 2MB only )

OTP : *

{{--

Salutation: *

Surname: *

Name: *

Father / Husband Name: *

Mother's Name: *

Upload Profile

Pincode : *

Date Of Birth: *

Gender: *

Male Female

Marital Status:

Date of Marriage:

Blood Group: *

Mobile No1: * @if($errors->has('contact')) {{ $errors->first('contact')}} @endif

Mobile No2:

Landline No:

Khanp: *

UpKhanp:

Member Type: *

--}}

Back

{{--

Address & Qualification Details

Email Id:

Alternate Email Id:

City :

Occupation :

Address 1:

Address 2:

Address 3:

Family Address:

Office Address:

Other Address:

Native Address :

District : Pincode :

Qualification :

Company Details :

Resident Proof :

Back

--}}