Vasti Patrak Nihani Form
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Name
Husband Name
Surname
Village Name (Gaam)
Father Full Name
Address Line 1
Address Line 2
City
Area
Zone
— Select —
East
West
N/A
Pin Code
Mobile No.
WhatsApp Number
Landline
*Email
Date Of Birth
Date Of Marriage
Blood Group
— Select —
A+
A-
B+
B-
AB+
AB-
O+
O-
Children 1
Full Name
Date Of Birth
Maritual Status
Married
Unmarried
Children 2
Full Name
Date Of Birth
Maritual Status
Married
Unmarried
Children 3
Full Name
Date Of Birth
Maritual Status
Married
Unmarried
Submit
For Any Help or Suggestions in Form Pls Contact
Nirav Gangar - 9867760140
Chintan Shah - 7303545864