State Select Andra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Madya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttaranchal Uttar Pradesh West Bengal UNION Territories Andaman and Nicobar Islands Chandigarh Dadar and Nagar Haveli Daman and Diu Delhi Lakshadeep Pondicherry

District Select

Municipality

Municipality Ward No

House No

Police Station

Name of House Owner

Resident Since

Mobile No

PIN Code

Total Family Members

Non Aadhar Family Members

Non Voter Family Members

Passport Choose One Yes No

Ownership Type (Single/Partnership) Choose One Single Partnership

Status of Property (Pakka/Kacha) Select Pakka Kacha

Last Payments Years

Govt Water Facility Select Yes No

Bore Well Select Yes No

Latrine Toilet Select Yes No

Electricity Select Yes No