CHD LABOUR DEPARTMENT

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Applicant Name *		Enter Max 99 Characters
Applicant Father/ Husband Name *		Enter Max 99 Characters
Applicant Gender *
Aadhar No.		Enter 12 Digits Aadhar No.
Mobile No(+91) *		Enter 10 Digits Mobile No.
Email Address		Enter max 99 character (Working Email Id)
Date of Birth *		Date of birth(dd/MM/yyyy)
House No/Flat No *		Enter Max 60 Characters
Country *		Select Country
State/UT *		Select State
District *		Select District
Locality (Sector/Village) *		Select Locality
Tehsil *		Enter Max 50 Characters
Pin Code *		Enter 6 digit Pin Code
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Enter Captcha *		Enter Code Shown Above
Upload Signature *		Upload Signature (Only JPG File)