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Security Question:	Select Security Question What is your mother's Maiden name? What is your pets name ? What was the name of your first school? Who was your childhood hero? Who is your favourite sports person? What is your favorite past-time? What is your all-time favourite sports team? What was your high school mascot? What make was your first car or bike? Where did you first meet your spouse? *
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Type of candidate:	Select Candidate DP Staff Auditor Others *
Personal Information
Salutation:	Select Salutation Mr Ms Mrs *
First Name:	*
Middle Name:
Last Name:
Name to appear in Certificate: (Name as on PAN)	*
Gender:	Select Gender Female Male *
Date of Birth:	*
Address for communication
Address1:	*
Address2:
Address3:
State:	Select State ANDAMAN AND NICOBAR ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHATTISGARH DADRA AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJRAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ORISSA PONDICHERRY PUNJAB RAJASTHAN SIKKIM TAMILNADU TRIPURA UTTAR PRADESH UTTARAKHAND WEST BENGAL CHANDIGARH TELANGANA *
City:	Select City *
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Country:
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Telephone No:	-
Email ID:	*
Pan:	*
Other Reference No.1:	(As specified for specific CPEs such as ARN No.)
Other Reference No.2:	(As specified for specific CPEs such as AMFI certificate No.)
NSR No.:
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