New Registration - KARNATAKA STATE LICENSED ELECTRICAL CONTRACTORS ASSOCIATION (R)

Membership Application Details

Name of the Applicant (In Block Letters) *

Father/Husband Name*

Date of Birth *

Aadhar Number *

Applicant Address *

State*

District *

Taluk *

Pincode *

Mobile No *

Alternate Mobile No

Email-Id

Name of the Nominee *

Relationship of the Nominee *

Name of the Firm*

Address of the Firm *

License Number *

Date of License Issued *

Date of License Validity *

Upload Photo *

Allowed Types:jpg, png, jpeg

File Size: Below 100 KB

Upload Signature *

Allowed Types:jpg, png, jpeg

File Size: Below 50 KB

Upload License *

Allowed Types:jpg / jpeg / png / pdf

File Size: Greater Than 10kb & Lesser Than 500kb

Upload Nominee Form*

Allowed Types:jpg / jpeg / png / pdf

File Size: Greater Than 10kb & Lesser Than 500kb

Upload Aadhar *

Allowed Types:jpg / jpeg / png / pdf

File Size: Greater Than 10kb & Lesser Than 500kb

Security Code *

I Will abide by the Rules & Regulations of the Association from time to time

I Agree, The Terms And Conditions