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Fields marked with an asterisk * are required
Register Type*
Email address *
  email address should be active
Create password *
  password must be 6 characters
Retype password *
   
SMPB Registration No.
  If already registered with SMPB quote your Unique Registration No.
Panchayat Regi. No.:
Name of the Panchayat:
Company name
  Leave blank if individual
Company Regi. No.:
  Leave blank if individual
Pan Card No.:
Pan Card :
Voter ID Card No.:
Voter ID Card :
Nationalized Bank :
Contact Information
   
First name *
  Ex. Ramesh Kumar
Last name *
  Ex. Sahoo
Photo :
Address 1 *
Address 2
Village / Town / City *
District*
State*
Country*
Pincode*
Phone Number
Mobile Number *
  mobile number would be verified
I have read and accept the SMPB terms and conditions
I agree to receive occasional email/sms alerts from SMPB regarding medicinal plants and trade
 

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