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Applicant

Nodal Officer

PESB

PAN Number

Full Name

Father's name*

Date of Birth*

Email id*

Mobile number*

Address*

Upload passport size photograph here

Ensure to upload photograph in .JPG, .JPEG format with size not more than 50kb

Upload signature here

Ensure to upload scanned signature in .JPG, .JPEG format with size not more than 25kb

Upload Nomination Document

Ensure to upload scanned nomination document in .PDF format with size not more than 1mb

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