User Registration
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Name
*
First
Middle
Last
বাংলা নাম
*
First
Middle
Last
Name of Father/Mother/Husband Name
*
First
Middle
Last
পিতা/মাতার নাম/স্বামীর নাম
*
First
Middle
Last
Phone Number
*
Layout
Membership No.
Date of Membership
Layout
Receipt Number
*
Receipt Date
*
Layout
Date Of Birth
*
Gender
*
Male
Male
Female
Photo
*
Click or drag a file to this area to upload.
Layout
Email
*
Password
Address
Layout
Village
*
Post Office
*
Block
*
District
*
PIN
*
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Layout
Occupation
Type of Work
*
Fishing
Fishing
Fish Vendor
Fish Processing Unit
Net Mender
Boat Crew
Boat Owner
Fish Sorter
Fish Farmer
Working in Fish Farming
Layout
Education
Religion
*
Hindu
Hindu
Muslim
Christianity
Layout
Caste
*
SC
SC
ST
OBC
General
Caste Certificate No.
Adhaar Card No.
*
Adhaar Card Photo (Both Side)
*
Click or drag files to this area to upload.
You can upload up to 2 files.
EPIC No.
Boat Registration No.
Fisher's ID Card No.
Legal Heir
Husband
Wife
Name of Legal Heir
First
Middle
Last
Date of Birth of Legal Heir
Layout
Adhar Card No. of Legal Heir
Voter ID Card of Legal Heir
Application Form
*
Click or drag a file to this area to upload.
Account No
IFSC Code
Layout
Bank Name
Branch
Submit