SERVICE PROVIDER

SERVICE PROVIDER EMPANELMENT FORM

NOTE:-If service providers, faculties, and institutes do not pay their empanelment fees within 30 days after RO approval, their names will be deleted from the database. They must re-register for empanelment. This rule will be effective from 01.04.2026.

INFORMATION

Profession *

Full Name *

Qualification

Experience

Computer Knowledge *

Typing Skills

Speed (WPM)

ADDRESS AND CONTACT DETAILS

House No. / Survey No. *

Area / Colony *

Landmark *

District *

Taluka

Pincode * Must be exactly 6 digits (e.g., 431001)

Mobile No *

Email *

BANK DETAILS

PAN No. *

Aadhaar No. *

Bank Name *

Branch

Account No. *

IFSC Code *

GST No

Empanelment Period *

Subscription Fee

Select Profession to view subscription fee

Select Officer Name