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Personal Details
Full Name
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Email Address
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Phone Number
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Valid 10-digit number required.
Date of Birth
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Date of birth required.
Gender
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Marital Status
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Address Information
State
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Required.
District
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Required.
Pin Code
*
Valid 6-digit pin.
Complete Address
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Security
Password
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Min 6 chars, 1 uppercase, 1 lowercase, 1 number, 1 special char.
Confirm Password
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Passwords do not match.
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