Senior Citizen's Registration Form:
Name of Person:
Upload Photo:
your image
Marital Status: Married Unmarried
Sex:
Present Engagement Type:
Mobile no:
Email id:
Blood Group:
Present Mailing Address :
District:
Block:
Municipality / NAC:
Gram Panchayat:
Pincode:
Educational Qualification:
Qualification Detail(e.g M.B.B.S,LLB,B.A, B.Tech, B.E etc):
EPIC / Voter ID Card No:
Aadhaar No:
PAN No:
Health Profile(Diseases Suffering From):
Source of Treatment Assistance:
Present Annual Income:
Previous year Income Tax Paid:
Immovable Property Owned (Land / Building):
Vehicle Type :
Vehicle No :
Hobbies:
Present Living Status:
Whether Spouse Alive or notYesNo
Area of Expertise:
How are you presently engaged:
How do you propose to engage yourself:
Are you willing to work as volunteer for social serviceYesNo
If Yes Please specify area of interest(No Remuneration will be provided but full logistic support will be provided)
Places Visited:
Are you interested in getting spiritual support serviceYesNo
Problem Encountered:
Specify special contributions made by you during lifetime:
Awards and recognition received:
Important contribution made:
Describe the important contribution made
(please enter the security code shown before submitting)
(Can’t read the image? click here to refresh)
  

Copyright © 2017. All rights Reserved. Site Designed & Developed by:

CENTRE FOR MODERNIZING GOVERNMENT INITIATIVE (CMGI)
(A SOCIETY UNDER GENERAL ADMINISTRATION (AR) DEPARTMENT)
GOVERNMENT OF ODISHA

SISHU BHAWAN SQUARE, UDYAN MARG,INFRONT OF CANARA BANK, BHUBANESWAR-751009. PHONE: 0674-2567571, 2567083. FAX: 0674-2567083.
Website: http://www.cmgi.org.in/