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User Login Login : Password : Please Enter The Security Code shown in the Text Box Provided. (Case Sensitive) Load New Code New Applicant	APPLICANT REGISTRATION [ Guidelines for Retail Outlet or Private Property ] Applicant Type * ----Select---- Empanelled Consultant Select Applicant type Company/Organisation Name : Please Enter Company/Organisation Name Select Access Permission :* ----Select---- Fuel StationPrivate PropertyOthers Select Access Permission. Name of Applicant * Please do not use any prefix such as Mr, Ms etc Name of Contact Person* Please do not use any prefix such as Mr, Ms etc PAN Number* Please Enter PAN Number Aadhar Card Please Enter Aadhar Card Number Applicant Contact Address* Contact Address of Person/Company State* ---Select--- ANDAMAN & NICOBAR ISLANDSANDHRA PRADESHARUNACHAL PRADESHASSAMBIHARCHANDIGARHCHHATTISGARHDADRA & NAGAR HAVELIDAMAN & DIUDELHIGOAGUJARATHARYANAHIMACHAL PRADESHJAMMU & KASHMIRJHARKHANDKARNATAKAKERALALAKSHADWEEPMADHYA PRADESHMAHARASHTRAMANIPURMEGHALAYAMIZORAMNAGALANDORISSAPONDICHERRYPUNJABRAJASTHANSIKKIMTAMIL NADUTELANGANATRIPURAUTTAR PRADESHUTTARANCHALWEST BENGAL   District* ---Select---   PIN*   Contact No.* Enter Comma in case of multiple contact nos (Landline Number / Mobile Number).. Email* Please Enter The Security Code shown in the Text Box Provided.  (Case Sensitive) Load New Code  I hereby declare that the information provided in the form are true to the best of my knowledge and belief.
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