Yes No     If Yes please specify
Communication Address
Permanent Address
Copy of Govt. approved identity card with photo, with the same address as that in the licensee certificate, attested by a gazetted officer within one month from the date of application
Recent passport size photo - Taken within six months prior to the date of application shall be uploaded – please ensure that the photo uploaded is of passport size and gives a front and clear view of the face.
Registration certificate of the licensee – copy attested by a gazette officer, including office seal,attested within one month prior to the date of application, to be scanned and uploaded. ( including renewal certificate if any)
Details of show cause notice received/cancellations of licenses if any
Educational Certificates
Experience Certificate
Others
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