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Customer Form

Please Note the following:

  1. Information once submitted on this form will be used for all the application that you submit and cannot be modify later without the approval of the department. Please fill the information as per the documents that will be submitted as proof.
  2. The Captcha characters are case sensitive. Please enter them exactly as it appears int he right of textbox.
  3. Login ID should be minimum five characters in length and can consist of letters and numbers only.
  4. Fields marked with * are mandatory.