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First Appeal Application Form / प्रथम अपील आवेदन पत्र:
Department Required
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Applicant's Details /आवेदक का विवरण:

Only 10 digit numbers are allowed.
Verified
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Mobile no. required Not a valid number

Date of Application Required
email required Not valid email
Father Name required
Officer Details Required
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Address of Service Provider Office / सेवा प्रदाता कार्यालय का पता :
State Required
District Required
Subdivision Required
Block Required


Present Address of Applicant / आवेदक का वर्तमान पता :
State Required
District Required
Subdivision Required
Block Required
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Other Details / अन्य विवरण:

Appeal reason Required
Only English letters, numbers, space, dot (.), comma (,), slash (/), and hyphen (-) allowed. Hindi not allowed.
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Relief Sought / मांगी गई राहत अनिवार्य है
Reason of rejection Required

Document Upload / दस्तावेज़ अपलोड करें:

Choose file Required

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