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Office Type* Select Valid Office Type

Department * Select Valid Department

Head of the Department* Select Valid HOD

Collectorate* Select Valid District

Office Name*

Enter Office Name

Officer Name or Designation or Section*

Enter Section or Officer Designation

Contact Mobile Number *

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Email*

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Alternate Mobile Number

Alternate Email

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Office Landline Number*

STD Code should have more than 3 number Landline number should have more than 6 numbers

Office Address *

Office Address Should be more than 3 words

District*

Select Valid District

Pincode*

Select Valid District

Officer Signed request letter
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Officer Signed request letter - File Size Should be < 2MB and File types allowed (pdf, img, jpg, jpeg)