Application Form for Registration of Transgender

Personal Details
1. Name of the applicant:
* (a) Current Name : * (b) Previous Name (If any) :
2. Mother's Name : 3. Father's Name :
4. Annual income of the mother : 5. Annual income of the father :
6. Annual source of Income : 7. Annual Income :
8. Caste of the mother : 9. Caste of the father :
10. Date of Birth : (MM/DD/YYYY) Occupation:
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* 11. Present address:
Village / Town:-
P.O / P.S:- Block / NAC / Municipality :-
District:- PIN Code:-
* 12. Permanent address:
Village / Town:-
P.O / P.S:- Block / NAC / Municipality :-
District:- PIN Code:-
13. Whether belongs to SC/ST/SEBC : 14. Religion :
15. Educational Qualification : 16. Aadhaar No :
17. Contact details:
* Mobile No: E-mail ID :
18. Other details:
Blood Group: Educational Qualification:
Qualification Detail(e.g M.B.B.S,LLB,B.A, B.Tech, B.E etc): EPIC / Voter ID Card No:
PAN No: Health Profile(Diseases Suffering From):
Source of Treatment Assistance: Present Annual Income:
Select Training Immovable Property Owned (Land / Building):
Vehicle Type : Vehicle No:
Hobbies: Present Living Status:
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 Places Visited: Places Visited Details
Are you interested in getting spiritual support serviceYesNo Problem Encountered: Problem Faced Details
Specify special contributions made by you during lifetime: Awards and recognition received:
Important contribution made: Describe the important contribution made
Declaration:
19. Since I am a transgender person, I hereby declare my gender is changed from to
20. I am herewith submitting this application requesting the State Government for registration.
21. I hereby certify that all the information furnished by me above are true to the best of my knowledge and belief. I shall be liable for prosecution if any of the information furnished above by me is found to be false.
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