Supervisor Registration

Full Name *

Mobile Number *

Gender

Date of Birth

Father's Name

Address

District

Pincode

Zonal Administrator Zone *

Qualification *

Qualification Certificates (along with relevant Experience)*

Previous HSVP Empanelment Letter (if any)

I declare that:

The information and documents furnished in this application are true, correct, and complete to the best of my knowledge and belief. I understand that any false statement or concealment of material facts will render this application liable to be rejected.
Submission of any incorrect information, forged documents, or misrepresentation of facts shall attract disciplinary action, including rejection of the application and blacklisting from future registrations.

Note: This declaration is mandatory. The submit button will be enabled only after you accept it.

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