| Sl.NO |
Particulars |
Remarks |
| 1 |
ENROLMENT NUMBER |
|
| 2 |
NAME |
|
| |
DATE OF ENROLLMENT |
|
| 3 |
DATE OF BIRTH |
|
| 4 |
FATHER’S / SPOUSE NAME |
|
| 5 |
ADDRESS |
|
| 6 |
PLACE OF PRACTICE |
|
| 7 |
DISTRICT |
|
| 8 |
TALUK |
|
| 9 |
MOBILE NO |
|
| 10 |
EMAIL ID |
|
| 11 |
HAVE YOU FILED COP ? |
|
| 12 |
ARE YOU AN INCOME TAX ASSESSEE ? |
|
| 13 |
DO YOU/YOUR SPOUSE HAVE ANY OTHER SOURCE OF INCOME ? |
|
| 14 |
ARE YOU GETTING ANY PENSION ? |
|
| 15 |
HAVE YOU OBTAINED ANY COVID-19 FINANCIAL ASSISTANCE FROM GOVERNMENT / ADVOCATES ASSOCIATION ? |
|
| 16 |
DO YOU/YOUR SPOUSE OWN A FOUR WHEELER ? |
|
| 17 |
DATE OF APPLICATION |
|
| 18 |
BANK ACCOUNT NUMBER |
|
| |
IFSC CODE |
|
| |
ACCOUNT NAME |
|
| |
BANK NAME |
|
| |
BRANCH NAME |
|