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Second Appeal Application Form / द्वितीय अपील आवेदन पत्र:

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Mobile no. required
Not a valid number
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OTP Verified
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Department Required
Application Reference Number Required

Applicant Details / आवेदक का विवरण:

Applicant Name Required
Date of Application Required
email required Not valid email
State Required
District Required
Subdivision Required
Block Required
Address Required

Address of Service Provider Office / सेवा प्रदाता कार्यालय का पता :
State Required
Subdivision Required
Block Required
Address Required

First Appeal Details / प्रथम अपील का विवरण:


Second Appeal Details / द्वितीय अपील 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

Choose file Required
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