Form Fill | Prime Laravel Form Builder

Hours

Minutes

Seconds

Agency Registration

Contact Details

Mobile Number *

Email ID

Telephone

Details of Applicant

First Name *

Middle Name

Last Name *

Date Of Birth

Gender *

Name Of Agency *

Mode of Advertisement *

Property Address

EasyCity Code

Address *

Upload Documents

Identity Proof (Any One) *

Document Number

File Upload

Applicant Photo

Your captured image will appear here...

Bank Details

IFSC Code *

Bank Name *

Branch Name *

Account Holder Name  *

Account Number *

The information provided can't be changed once submitted, confirm to proceed

I will abide to The Rules “Dadra and Nagar Haveli Municipal Council (Tax on Advertisement) Rules, 2018 in the case of registration as well as Application before paying any fees..