Name * :		}	# Same as in aadhar (Do not use title/salutation e.g. Mr./Ms./Sri/Smt. etc. before name)
Father's Name * :
Date of Birth * :
Religion * :	---- Select ---- Islam Christian Shikh Buddhist Jain Parsi
Domicile of Bihar *:	---- Select ---- Yes
Physically Handicapped :
Gender *:	-Select- Male Female Other
Email *:	*
Mobile No. *:	-
Create Password *:
Create Confirm Password *:
Enter Code Shown :
Note :- Fields marked with * are mandatory