{"id":6,"date":"2021-04-08T10:16:32","date_gmt":"2021-04-08T10:16:32","guid":{"rendered":"https:\/\/jmstrust.com\/enrolment\/?page_id=6"},"modified":"2022-09-26T09:00:23","modified_gmt":"2022-09-26T09:00:23","slug":"scholarship-scheme-application-form","status":"publish","type":"page","link":"https:\/\/jmstrust.com\/enrolment\/","title":{"rendered":"Scholarship Scheme Application Form"},"content":{"rendered":"<body>\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6\" class=\"elementor elementor-6\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b55fae7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b55fae7\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-f470e58\" data-id=\"f470e58\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-f923f49\" data-id=\"f923f49\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-945bdef elementor-widget elementor-widget-text-editor\" data-id=\"945bdef\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>(<strong>To<\/strong>: JM Sethia Charitable trust of 16, Ganesh Chandra Avenue, Kolkata-700013,West Bengal, INDIA, <b>fon:<\/b>\u00a0+91-33-2236 0368,4040 1300,<strong> mob :<\/strong> +91-9339793153, West Bengal, INDIA, <strong>e-mail: <\/strong>jms_trust@yahoo.in, <strong>website:<\/strong> www.jmstrust.com)<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-f6b5ac4\" data-id=\"f6b5ac4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-46db7553 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"46db7553\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1c61c8ad\" data-id=\"1c61c8ad\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;gradient&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8bb2f9a elementor-widget elementor-widget-text-editor\" data-id=\"8bb2f9a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4><strong>\u00a0 \u00a0Note :\u00a0 INSTRUCTION :-<\/strong><\/h4>\n<ul>\n<li style=\"font-size: 18px;\">Do not Fillip application form repeatedly.<\/li>\n<li style=\"font-size: 18px;\">Form Should be Fill up in English letters only (Do not use any regional language).<\/li>\n<li style=\"font-size: 18px;\">Scholarship scheme is not applicable for candidates preparing for competitive exams.<\/li>\n<\/ul><p style=\"font-size:20px\" ;><b>Date for<\/b> <b style=\"color: red;\">Submission<\/b> <b>of Application form<\/b> \u2013 April to July; <b>Date Of<\/b> <b style=\"color: red;\">Selection<\/b> <b>of Candidate<\/b> \u2013 August and <b>Date of <\/b> <b style=\"color: red;\">Disbursement<\/b><b> of Scholarship<\/b> \u2013 September <b>OR<\/b> within the month prior to the next quarter<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ad734c1 elementor-widget elementor-widget-text-editor\" data-id=\"1ad734c1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\n<p class=\"wp-block-contact-form-7-contact-form-selector\" style=\"text-align: left;\">\n<\/p><div class=\"wpcf7 no-js\" id=\"wpcf7-f5-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"5\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/enrolment\/wp-json\/wp\/v2\/pages\/6#wpcf7-f5-o1\" method=\"post\" class=\"wpcf7-form init wpcf7-acceptance-as-validation\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"5\"><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\"><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\"><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f5-o1\"><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\"><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\">\n<\/fieldset>\n<!----<h4>Merit Scholarship Scheme Application Form <\/h4>---->\n\n\n<!---<fieldset>\n\n\n<legend>Personal Information<\/legend>-->\n<p style=\"color: red\" ;>* Required Mandatory\n<\/p>\n<p><label> GENERAL INFORMATION (Category applied for Pl. Tick ) Please refer to the scheme<br>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"Info\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"Info\" value=\"A\" checked><span class=\"wpcf7-list-item-label\">A<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"Info\" value=\"B\"><span class=\"wpcf7-list-item-label\">B<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"Info\" value=\"C\"><span class=\"wpcf7-list-item-label\">C<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"Info\" value=\"D\"><span class=\"wpcf7-list-item-label\">D<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"Info\" value=\"P\"><span class=\"wpcf7-list-item-label\">P<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"Info\" value=\"O\"><span class=\"wpcf7-list-item-label\">O<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label><b> 1.Your name\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"50\" minlength=\"9\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\"><\/span><\/b> <\/label>\n<\/p>\n<p><label> <b>2. Upload Your Passport Size Photo (Size: 1mb) <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Profile\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" multiple data-name=\"Profile\" data-type=\"jpg|jpeg|png|gif|xcel|word|pdf\" data-limit=\"10097152\" data-min=\"1\" data-max=\"10\" data-id=\"5\" data-version=\"free version 1.3.9.8\" accept=\".jpg, .jpeg, .png, .gif, .xcel, .word, .pdf\"><\/span><br>\n<\/label>\n<\/p>\n<p><label> <b>3.Son\/ Daughter of\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SonDaughterof\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"SonDaughterof\"><\/span> <\/b><br>\n<\/label>\n<\/p>\n<p><label> <b>4.Date of birth :<\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Dateofbirth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"1976-10-09\" max=\"2036-09-09\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"Dateofbirth\"><\/span><\/label>\n<\/p>\n<p><label> <b> 5.Mobile No:\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"MobileNo\"><input size=\"40\" maxlength=\"10\" minlength=\"9\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"MobileNo\"><\/span> <\/b><br>\n<\/label>\n<\/p>\n<p><label> <b> 6.e-mail id:\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-460\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-460\"><\/span> <\/b><br>\n<\/label><br>\n<label> <b>7.Postal Address of the Applicant\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split> :<\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PostalAdress\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PostalAdress\"><\/span><\/label>\n<\/p>\n<p><label> <b>8.Pincode <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Pincode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Pincode\"><\/span><\/label>\n<\/p>\n<p><label> <b>9.Tel. No. (with STD Code)<\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-StdCode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-StdCode\"><\/span><\/label>\n<\/p>\n<p><label> <b>10.Select your States <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Residential_States\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Residential_States\"><option value=\"\">\u2014Please choose an option\u2014<\/option><option value=\"Select One\">Select One<\/option><option value=\"Andaman and Nicobar Islands (union territory)\">Andaman and Nicobar Islands (union territory)<\/option><option value=\"Andhra Pradesh\">Andhra Pradesh<\/option><option value=\"Arunachal Pradesh\">Arunachal Pradesh<\/option><option value=\"Assam\">Assam<\/option><option value=\"Bihar\">Bihar<\/option><option value=\"Chandigarh (union territory)\">Chandigarh (union territory)<\/option><option value=\"Chhattisgarh\">Chhattisgarh<\/option><option value=\"Dadra and Nagar Haveli (union territory)\">Dadra and Nagar Haveli (union territory)<\/option><option value=\"Daman and Diu (union territory)\">Daman and Diu (union territory)<\/option><option value=\"Delhi (national capital territory)\">Delhi (national capital territory)<\/option><option value=\"Goa\">Goa<\/option><option value=\"Gujarat\">Gujarat<\/option><option value=\"Haryana\">Haryana<\/option><option value=\"Himachal Pradesh\">Himachal Pradesh<\/option><option value=\"Jammu and Kashmir (union territory)\">Jammu and Kashmir (union territory)<\/option><option value=\"Jharkhand\">Jharkhand<\/option><option value=\"Karnataka\">Karnataka<\/option><option value=\"Kerala\">Kerala<\/option><option value=\"Ladakh (union territory)\">Ladakh (union territory)<\/option><option value=\"Madhya Pradesh\">Madhya Pradesh<\/option><option value=\"Maharashtra\">Maharashtra<\/option><option value=\"Manipur\">Manipur<\/option><option value=\"Meghalaya\">Meghalaya<\/option><option value=\"Mizoram\">Mizoram<\/option><option value=\"Nagaland\">Nagaland<\/option><option value=\"Odisha\">Odisha<\/option><option value=\"Puducherry (union territory)\">Puducherry (union territory)<\/option><option value=\"Punjab\">Punjab<\/option><option value=\"Rajasthan\">Rajasthan<\/option><option value=\"Sikkim\">Sikkim<\/option><option value=\"Tamil Nadu\">Tamil Nadu<\/option><option value=\"Telangana\">Telangana<\/option><option value=\"Tripura\">Tripura<\/option><option value=\"Uttar Pradesh\">Uttar Pradesh<\/option><option value=\"Uttarakhand\">Uttarakhand<\/option><option value=\"West Bengal\">West Bengal<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> <b> 11.Select your City <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Residential_City\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Residential_City\"><option value=\"\">\u2014Please choose an option\u2014<\/option><option value=\"Select One\">Select One<\/option><option value=\"Port Blair\">Port Blair<\/option><option value=\"Adoni\">Adoni<\/option><option value=\"Amaravati\">Amaravati<\/option><option value=\"Anantapur\">Anantapur<\/option><option value=\"Chandragiri\">Chandragiri<\/option><option value=\"Chittoor\">Chittoor<\/option><option value=\"Dowlaiswaram\">Dowlaiswaram<\/option><option value=\"Eluru\">Eluru<\/option><option value=\"Guntur\">Guntur<\/option><option value=\"Kadapa\">Kadapa<\/option><option value=\"Kakinada\">Kakinada<\/option><option value=\"Kurnool\">Kurnool<\/option><option value=\"Machilipatnam\">Machilipatnam<\/option><option value=\"Nagarjunako\u1e47\u1e0da\">Nagarjunako\u1e47\u1e0da<\/option><option value=\"Rajahmundry\">Rajahmundry<\/option><option value=\"Srikakulam\">Srikakulam<\/option><option value=\"Tirupati\">Tirupati<\/option><option value=\"Vijayawada\">Vijayawada<\/option><option value=\"Visakhapatnam\">Visakhapatnam<\/option><option value=\"Vizianagaram\">Vizianagaram<\/option><option value=\"Yemmiganur\">Yemmiganur<\/option><option value=\"Itanagar\">Itanagar<\/option><option value=\"Adoni\">Adoni<\/option><option value=\"Amaravati\">Amaravati<\/option><option value=\"Anantapur\">Anantapur<\/option><option value=\"Chandragiri\">Chandragiri<\/option><option value=\"Chittoor\">Chittoor<\/option><option value=\"Dowlaiswaram\">Dowlaiswaram<\/option><option value=\"Eluru\">Eluru<\/option><option value=\"Guntur\">Guntur<\/option><option value=\"Kadapa\">Kadapa<\/option><option value=\"Kakinada\">Kakinada<\/option><option value=\"Kurnool\">Kurnool<\/option><option value=\"Machilipatnam\">Machilipatnam<\/option><option value=\"Nagarjunako\u1e47\u1e0da\">Nagarjunako\u1e47\u1e0da<\/option><option value=\"Rajahmundry\">Rajahmundry<\/option><option value=\"Srikakulam\">Srikakulam<\/option><option value=\"Tirupati\">Tirupati<\/option><option value=\"Vijayawada\">Vijayawada<\/option><option value=\"Visakhapatnam\">Visakhapatnam<\/option><option value=\"Vizianagaram\">Vizianagaram<\/option><option value=\"Yemmiganur\">Yemmiganur<\/option><option value=\"Itanagar\">Itanagar<\/option><option value=\"Dhuburi\">Dhuburi<\/option><option value=\"Dibrugarh\">Dibrugarh<\/option><option value=\"Dispur\">Dispur<\/option><option value=\"Guwahati\">Guwahati<\/option><option value=\"Jorhat\">Jorhat<\/option><option value=\"Nagaon\">Nagaon<\/option><option value=\"Sibsagar\">Sibsagar<\/option><option value=\"Silchar\">Silchar<\/option><option value=\"Tezpur\">Tezpur<\/option><option value=\"Tinsukia\">Tinsukia<\/option><option value=\"Ara\">Ara<\/option><option value=\"Baruni\">Baruni<\/option><option value=\"Begusarai\">Begusarai<\/option><option value=\"Bettiah\">Bettiah<\/option><option value=\"Bhagalpur\">Bhagalpur<\/option><option value=\"Bihar Sharif\">Bihar Sharif<\/option><option value=\"Bodh Gaya\">Bodh Gaya<\/option><option value=\"Buxar\">Buxar<\/option><option value=\"Chapra\">Chapra<\/option><option value=\"Darbhanga\">Darbhanga<\/option><option value=\"Dehri\">Dehri<\/option><option value=\"Dinapur Nizamat\">Dinapur Nizamat<\/option><option value=\"Gaya\">Gaya<\/option><option value=\"Hajipur\">Hajipur<\/option><option value=\"Jamalpur\">Jamalpur<\/option><option value=\"Katihar\">Katihar<\/option><option value=\"Madhubani\">Madhubani<\/option><option value=\"Motihari\">Motihari<\/option><option value=\"Munger\">Munger<\/option><option value=\"Muzaffarpur\">Muzaffarpur<\/option><option value=\"Patna\">Patna<\/option><option value=\"Purnia\">Purnia<\/option><option value=\"Pusa\">Pusa<\/option><option value=\"Saharsa\">Saharsa<\/option><option value=\"Samastipur\">Samastipur<\/option><option value=\"Sasaram\">Sasaram<\/option><option value=\"Sitamarhi\">Sitamarhi<\/option><option value=\"Siwan\">Siwan<\/option><option value=\"\"><\/option><option value=\"Ambikapur\">Ambikapur<\/option><option value=\"Bhilai\">Bhilai<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Dhamtari\">Dhamtari<\/option><option value=\"Durg\">Durg<\/option><option value=\"Jagdalpur\">Jagdalpur<\/option><option value=\"Raipur\">Raipur<\/option><option value=\"Rajnandgaon\">Rajnandgaon<\/option><option value=\"Silvassa\">Silvassa<\/option><option value=\"Daman\">Daman<\/option><option value=\"Diu\">Diu<\/option><option value=\"Delhi\">Delhi<\/option><option value=\"New Delhi\">New Delhi<\/option><option value=\"Madgaon\">Madgaon<\/option><option value=\"Panaji\">Panaji<\/option><option value=\"Ahmadabad\">Ahmadabad<\/option><option value=\"Amreli\">Amreli<\/option><option value=\"Bharuch\">Bharuch<\/option><option value=\"Bhavnagar\">Bhavnagar<\/option><option value=\"Bhuj\">Bhuj<\/option><option value=\"Dwarka\">Dwarka<\/option><option value=\"Gandhinagar\">Gandhinagar<\/option><option value=\"Godhra\">Godhra<\/option><option value=\"Jamnagar\">Jamnagar<\/option><option value=\"Junagadh\">Junagadh<\/option><option value=\"Kandla\">Kandla<\/option><option value=\"Khambhat\">Khambhat<\/option><option value=\"Kheda\">Kheda<\/option><option value=\"Mahesana\">Mahesana<\/option><option value=\"Morvi\">Morvi<\/option><option value=\"Nadiad\">Nadiad<\/option><option value=\"Navsari\">Navsari<\/option><option value=\"Okha\">Okha<\/option><option value=\"Palanpur\">Palanpur<\/option><option value=\"Patan\">Patan<\/option><option value=\"Porbandar\">Porbandar<\/option><option value=\"Rajkot\">Rajkot<\/option><option value=\"Surat\">Surat<\/option><option value=\"Surendranagar\">Surendranagar<\/option><option value=\"Valsad\">Valsad<\/option><option value=\"Veraval\">Veraval<\/option><option value=\"Ambala\">Ambala<\/option><option value=\"Bhiwani\">Bhiwani<\/option><option value=\"Chandigarh\">Chandigarh<\/option><option value=\"Faridabad\">Faridabad<\/option><option value=\"Firozpur Jhirka\">Firozpur Jhirka<\/option><option value=\"Gurgaon\">Gurgaon<\/option><option value=\"Hansi\">Hansi<\/option><option value=\"Hisar\">Hisar<\/option><option value=\"Jind\">Jind<\/option><option value=\"Kaithal\">Kaithal<\/option><option value=\"Karnal\">Karnal<\/option><option value=\"Kurukshetra\">Kurukshetra<\/option><option value=\"Panipat\">Panipat<\/option><option value=\"Pehowa\">Pehowa<\/option><option value=\"Rewari\">Rewari<\/option><option value=\"Rohtak\">Rohtak<\/option><option value=\"Sirsa\">Sirsa<\/option><option value=\"Sonipat\">Sonipat<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Chamba\">Chamba<\/option><option value=\"Dalhousie\">Dalhousie<\/option><option value=\"Dharmshala\">Dharmshala<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Kangra\">Kangra<\/option><option value=\"Kullu\">Kullu<\/option><option value=\"Mandi\">Mandi<\/option><option value=\"Nahan\">Nahan<\/option><option value=\"Shimla\">Shimla<\/option><option value=\"Una\">Una<\/option><option value=\"Anantnag\">Anantnag<\/option><option value=\"Baramula\">Baramula<\/option><option value=\"Doda\">Doda<\/option><option value=\"Gulmarg\">Gulmarg<\/option><option value=\"Jammu\">Jammu<\/option><option value=\"Kathua\">Kathua<\/option><option value=\"Punch\">Punch<\/option><option value=\"Rajauri\">Rajauri<\/option><option value=\"Srinagar\">Srinagar<\/option><option value=\"Udhampur\">Udhampur<\/option><option value=\"Bokaro\">Bokaro<\/option><option value=\"Chaibasa\">Chaibasa<\/option><option value=\"Deoghar\">Deoghar<\/option><option value=\"Dhanbad\">Dhanbad<\/option><option value=\"Dumka\">Dumka<\/option><option value=\"Giridih\">Giridih<\/option><option value=\"Hazaribag\">Hazaribag<\/option><option value=\"Jamshedpur\">Jamshedpur<\/option><option value=\"Jharia\">Jharia<\/option><option value=\"Rajmahal\">Rajmahal<\/option><option value=\"Ranchi\">Ranchi<\/option><option value=\"Saraikela\">Saraikela<\/option><option value=\"Badami\">Badami<\/option><option value=\"Ballari\">Ballari<\/option><option value=\"Bangalore\">Bangalore<\/option><option value=\"Belgavi\">Belgavi<\/option><option value=\"Bhadravati\">Bhadravati<\/option><option value=\"Bidar\">Bidar<\/option><option value=\"Chikkamagaluru\">Chikkamagaluru<\/option><option value=\"Chitradurga\">Chitradurga<\/option><option value=\"Davangere\">Davangere<\/option><option value=\"Halebid\">Halebid<\/option><option value=\"Hassan\">Hassan<\/option><option value=\"Hubballi-Dharwad\">Hubballi-Dharwad<\/option><option value=\"Kalaburagi\">Kalaburagi<\/option><option value=\"Kolar\">Kolar<\/option><option value=\"Madikeri\">Madikeri<\/option><option value=\"Mandya\">Mandya<\/option><option value=\"Mangaluru\">Mangaluru<\/option><option value=\"Mysuru\">Mysuru<\/option><option value=\"Raichur\">Raichur<\/option><option value=\"Shivamogga\">Shivamogga<\/option><option value=\"Shravanabelagola\">Shravanabelagola<\/option><option value=\"Shrirangapattana\">Shrirangapattana<\/option><option value=\"Tumkuru\">Tumkuru<\/option><option value=\"Alappuzha\">Alappuzha<\/option><option value=\"Badagara\">Badagara<\/option><option value=\"Idukki\">Idukki<\/option><option value=\"Kannur\">Kannur<\/option><option value=\"Kochi\">Kochi<\/option><option value=\"Kollam\">Kollam<\/option><option value=\"Kottayam\">Kottayam<\/option><option value=\"Kozhikode\">Kozhikode<\/option><option value=\"Mattancheri\">Mattancheri<\/option><option value=\"Palakkad\">Palakkad<\/option><option value=\"Thalassery\">Thalassery<\/option><option value=\"Thiruvananthapuram\">Thiruvananthapuram<\/option><option value=\"Thrissur\">Thrissur<\/option><option value=\"Balaghat\">Balaghat<\/option><option value=\"Barwani\">Barwani<\/option><option value=\"Betul\">Betul<\/option><option value=\"Bharhut\">Bharhut<\/option><option value=\"Bhind\">Bhind<\/option><option value=\"Bhojpur\">Bhojpur<\/option><option value=\"Bhopal\">Bhopal<\/option><option value=\"Burhanpur\">Burhanpur<\/option><option value=\"Chhatarpur\">Chhatarpur<\/option><option value=\"Chhindwara\">Chhindwara<\/option><option value=\"Damoh\">Damoh<\/option><option value=\"Datia\">Datia<\/option><option value=\"Dewas\">Dewas<\/option><option value=\"Dhar\">Dhar<\/option><option value=\"Guna\">Guna<\/option><option value=\"Gwalior\">Gwalior<\/option><option value=\"Hoshangabad\">Hoshangabad<\/option><option value=\"Indore\">Indore<\/option><option value=\"Itarsi\">Itarsi<\/option><option value=\"Jabalpur\">Jabalpur<\/option><option value=\"Jhabua\">Jhabua<\/option><option value=\"Khajuraho\">Khajuraho<\/option><option value=\"Khandwa\">Khandwa<\/option><option value=\"Khargon\">Khargon<\/option><option value=\"Maheshwar\">Maheshwar<\/option><option value=\"Mandla\">Mandla<\/option><option value=\"Mandsaur\">Mandsaur<\/option><option value=\"Mhow\">Mhow<\/option><option value=\"Morena\">Morena<\/option><option value=\"Murwara\">Murwara<\/option><option value=\"Narsimhapur\">Narsimhapur<\/option><option value=\"Narsinghgarh\">Narsinghgarh<\/option><option value=\"Narwar\">Narwar<\/option><option value=\"Neemuch\">Neemuch<\/option><option value=\"Nowgong\">Nowgong<\/option><option value=\"Orchha\">Orchha<\/option><option value=\"Panna\">Panna<\/option><option value=\"Raisen\">Raisen<\/option><option value=\"Rajgarh\">Rajgarh<\/option><option value=\"Ratlam\">Ratlam<\/option><option value=\"Rewa\">Rewa<\/option><option value=\"Sagar\">Sagar<\/option><option value=\"Sarangpur\">Sarangpur<\/option><option value=\"Satna\">Satna<\/option><option value=\"Sehore\">Sehore<\/option><option value=\"Seoni\">Seoni<\/option><option value=\"Shahdol\">Shahdol<\/option><option value=\"Shajapur\">Shajapur<\/option><option value=\"Sheopur\">Sheopur<\/option><option value=\"Shivpuri\">Shivpuri<\/option><option value=\"Ujjain\">Ujjain<\/option><option value=\"Vidisha\">Vidisha<\/option><option value=\"Ahmadnagar\">Ahmadnagar<\/option><option value=\"Akola\">Akola<\/option><option value=\"Amravati\">Amravati<\/option><option value=\"Aurangabad\">Aurangabad<\/option><option value=\"Bhandara\">Bhandara<\/option><option value=\"Bhusawal\">Bhusawal<\/option><option value=\"Bid\">Bid<\/option><option value=\"Buldana\">Buldana<\/option><option value=\"Chandrapur\">Chandrapur<\/option><option value=\"Daulatabad\">Daulatabad<\/option><option value=\"Dhule\">Dhule<\/option><option value=\"Jalgaon\">Jalgaon<\/option><option value=\"Kalyan\">Kalyan<\/option><option value=\"Karli\">Karli<\/option><option value=\"Kolhapur\">Kolhapur<\/option><option value=\"Mahabaleshwar\">Mahabaleshwar<\/option><option value=\"Malegaon\">Malegaon<\/option><option value=\"Matheran\">Matheran<\/option><option value=\"Mumbai\">Mumbai<\/option><option value=\"Nagpur\">Nagpur<\/option><option value=\"Nanded\">Nanded<\/option><option value=\"Nashik\">Nashik<\/option><option value=\"Osmanabad\">Osmanabad<\/option><option value=\"Pandharpur\">Pandharpur<\/option><option value=\"Parbhani\">Parbhani<\/option><option value=\"Pune\">Pune<\/option><option value=\"Ratnagiri\">Ratnagiri<\/option><option value=\"Sangli\">Sangli<\/option><option value=\"Satara\">Satara<\/option><option value=\"Sevagram\">Sevagram<\/option><option value=\"Solapur\">Solapur<\/option><option value=\"Thane\">Thane<\/option><option value=\"Ulhasnagar\">Ulhasnagar<\/option><option value=\"Vasai-Virar\">Vasai-Virar<\/option><option value=\"Wardha\">Wardha<\/option><option value=\"Yavatmal\">Yavatmal<\/option><option value=\"Imphal\">Imphal<\/option><option value=\"Cherrapunji\">Cherrapunji<\/option><option value=\"Shillong\">Shillong<\/option><option value=\"Aizawl\">Aizawl<\/option><option value=\"Lunglei\">Lunglei<\/option><option value=\"Kohima\">Kohima<\/option><option value=\"Mon\">Mon<\/option><option value=\"Phek\">Phek<\/option><option value=\"Wokha\">Wokha<\/option><option value=\"Zunheboto\">Zunheboto<\/option><option value=\"Balangir\">Balangir<\/option><option value=\"Baleshwar\">Baleshwar<\/option><option value=\"Baripada\">Baripada<\/option><option value=\"Bhubaneshwar\">Bhubaneshwar<\/option><option value=\"Brahmapur\">Brahmapur<\/option><option value=\"Cuttack\">Cuttack<\/option><option value=\"Dhenkanal\">Dhenkanal<\/option><option value=\"Keonjhar\">Keonjhar<\/option><option value=\"Konark\">Konark<\/option><option value=\"Koraput\">Koraput<\/option><option value=\"Paradip\">Paradip<\/option><option value=\"Phulabani\">Phulabani<\/option><option value=\"Puri\">Puri<\/option><option value=\"Sambalpur\">Sambalpur<\/option><option value=\"Udayagiri\">Udayagiri<\/option><option value=\"Karaikal\">Karaikal<\/option><option value=\"Mahe\">Mahe<\/option><option value=\"Puducherry\">Puducherry<\/option><option value=\"Yanam\">Yanam<\/option><option value=\"Amritsar\">Amritsar<\/option><option value=\"Batala\">Batala<\/option><option value=\"Chandigarh\">Chandigarh<\/option><option value=\"Faridkot\">Faridkot<\/option><option value=\"Firozpur\">Firozpur<\/option><option value=\"Gurdaspur\">Gurdaspur<\/option><option value=\"Hoshiarpur\">Hoshiarpur<\/option><option value=\"Jalandhar\">Jalandhar<\/option><option value=\"Kapurthala\">Kapurthala<\/option><option value=\"Ludhiana\">Ludhiana<\/option><option value=\"Nabha\">Nabha<\/option><option value=\"Patiala\">Patiala<\/option><option value=\"Rupnagar\">Rupnagar<\/option><option value=\"Sangrur\">Sangrur<\/option><option value=\"Abu\">Abu<\/option><option value=\"Ajmer\">Ajmer<\/option><option value=\"Alwar\">Alwar<\/option><option value=\"Amer\">Amer<\/option><option value=\"Barmer\">Barmer<\/option><option value=\"Beawar\">Beawar<\/option><option value=\"Bharatpur\">Bharatpur<\/option><option value=\"Bhilwara\">Bhilwara<\/option><option value=\"Bikaner\">Bikaner<\/option><option value=\"Bundi\">Bundi<\/option><option value=\"Chittaurgarh\">Chittaurgarh<\/option><option value=\"Churu\">Churu<\/option><option value=\"Dhaulpur\">Dhaulpur<\/option><option value=\"Dungarpur\">Dungarpur<\/option><option value=\"Ganganagar\">Ganganagar<\/option><option value=\"Hanumangarh\">Hanumangarh<\/option><option value=\"Jaipur\">Jaipur<\/option><option value=\"Jaisalmer\">Jaisalmer<\/option><option value=\"Jalor\">Jalor<\/option><option value=\"Jhalawar\">Jhalawar<\/option><option value=\"Jhunjhunu\">Jhunjhunu<\/option><option value=\"Jodhpur\">Jodhpur<\/option><option value=\"Kishangarh\">Kishangarh<\/option><option value=\"Kota\">Kota<\/option><option value=\"Merta\">Merta<\/option><option value=\"Nagaur\">Nagaur<\/option><option value=\"Nathdwara\">Nathdwara<\/option><option value=\"Pali\">Pali<\/option><option value=\"Phalodi\">Phalodi<\/option><option value=\"Pushkar\">Pushkar<\/option><option value=\"Sawai Madhopur\">Sawai Madhopur<\/option><option value=\"Shahpura\">Shahpura<\/option><option value=\"Sikar\">Sikar<\/option><option value=\"Sirohi\">Sirohi<\/option><option value=\"Tonk\">Tonk<\/option><option value=\"Udaipur\">Udaipur<\/option><option value=\"Gangtok\">Gangtok<\/option><option value=\"Gyalsing\">Gyalsing<\/option><option value=\"Lachung\">Lachung<\/option><option value=\"Mangan\">Mangan<\/option><option value=\"Arcot\">Arcot<\/option><option value=\"Chengalpattu\">Chengalpattu<\/option><option value=\"Chennai\">Chennai<\/option><option value=\"Chidambaram\">Chidambaram<\/option><option value=\"Coimbatore\">Coimbatore<\/option><option value=\"Cuddalore\">Cuddalore<\/option><option value=\"Dharmapuri\">Dharmapuri<\/option><option value=\"Dindigul\">Dindigul<\/option><option value=\"Erode\">Erode<\/option><option value=\"Kanchipuram\">Kanchipuram<\/option><option value=\"Kanniyakumari\">Kanniyakumari<\/option><option value=\"Kodaikanal\">Kodaikanal<\/option><option value=\"Kumbakonam\">Kumbakonam<\/option><option value=\"Madurai\">Madurai<\/option><option value=\"Mamallapuram\">Mamallapuram<\/option><option value=\"Nagappattinam\">Nagappattinam<\/option><option value=\"Nagercoil\">Nagercoil<\/option><option value=\"Palayankottai\">Palayankottai<\/option><option value=\"Pudukkottai\">Pudukkottai<\/option><option value=\"Rajapalaiyam\">Rajapalaiyam<\/option><option value=\"Ramanathapuram\">Ramanathapuram<\/option><option value=\"Salem\">Salem<\/option><option value=\"Thanjavur\">Thanjavur<\/option><option value=\"Tiruchchirappalli\">Tiruchchirappalli<\/option><option value=\"Tirunelveli\">Tirunelveli<\/option><option value=\"Tiruppur\">Tiruppur<\/option><option value=\"Tuticorin\">Tuticorin<\/option><option value=\"Udhagamandalam\">Udhagamandalam<\/option><option value=\"Vellore\">Vellore<\/option><option value=\"Hyderabad\">Hyderabad<\/option><option value=\"Karimnagar\">Karimnagar<\/option><option value=\"Khammam\">Khammam<\/option><option value=\"Mahbubnagar\">Mahbubnagar<\/option><option value=\"Nizamabad\">Nizamabad<\/option><option value=\"Sangareddi\">Sangareddi<\/option><option value=\"Warangal\">Warangal<\/option><option value=\"Agartala\">Agartala<\/option><option value=\"Agra\">Agra<\/option><option value=\"Aligarh\">Aligarh<\/option><option value=\"Amroha\">Amroha<\/option><option value=\"Ayodhya\">Ayodhya<\/option><option value=\"Azamgarh\">Azamgarh<\/option><option value=\"Bahraich\">Bahraich<\/option><option value=\"Ballia\">Ballia<\/option><option value=\"Banda\">Banda<\/option><option value=\"Bara Banki\">Bara Banki<\/option><option value=\"Bareilly\">Bareilly<\/option><option value=\"Basti\">Basti<\/option><option value=\"Bijnor\">Bijnor<\/option><option value=\"Bithur\">Bithur<\/option><option value=\"Budaun\">Budaun<\/option><option value=\"Bulandshahr\">Bulandshahr<\/option><option value=\"Deoria\">Deoria<\/option><option value=\"Etah\">Etah<\/option><option value=\"Etawah\">Etawah<\/option><option value=\"Faizabad\">Faizabad<\/option><option value=\"Farrukhabad-cum-Fatehgarh\">Farrukhabad-cum-Fatehgarh<\/option><option value=\"Fatehpur\">Fatehpur<\/option><option value=\"Fatehpur Sikri\">Fatehpur Sikri<\/option><option value=\"Ghaziabad\">Ghaziabad<\/option><option value=\"Ghazipur\">Ghazipur<\/option><option value=\"Gonda\">Gonda<\/option><option value=\"Gorakhpur\">Gorakhpur<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Hardoi\">Hardoi<\/option><option value=\"Hathras\">Hathras<\/option><option value=\"Jalaun\">Jalaun<\/option><option value=\"Jaunpur\">Jaunpur<\/option><option value=\"Jhansi\">Jhansi<\/option><option value=\"Kannauj\">Kannauj<\/option><option value=\"Kanpur\">Kanpur<\/option><option value=\"Lakhimpur\">Lakhimpur<\/option><option value=\"Lalitpur\">Lalitpur<\/option><option value=\"Lucknow\">Lucknow<\/option><option value=\"Mainpuri\">Mainpuri<\/option><option value=\"Mathura\">Mathura<\/option><option value=\"Meerut\">Meerut<\/option><option value=\"Mirzapur-Vindhyachal\">Mirzapur-Vindhyachal<\/option><option value=\"Moradabad\">Moradabad<\/option><option value=\"Muzaffarnagar\">Muzaffarnagar<\/option><option value=\"Partapgarh\">Partapgarh<\/option><option value=\"Pilibhit\">Pilibhit<\/option><option value=\"Prayagraj\">Prayagraj<\/option><option value=\"Rae Bareli\">Rae Bareli<\/option><option value=\"Rampur\">Rampur<\/option><option value=\"Saharanpur\">Saharanpur<\/option><option value=\"Sambhal\">Sambhal<\/option><option value=\"Shahjahanpur\">Shahjahanpur<\/option><option value=\"Sitapur\">Sitapur<\/option><option value=\"Sultanpur\">Sultanpur<\/option><option value=\"Tehri\">Tehri<\/option><option value=\"Varanasi\">Varanasi<\/option><option value=\"Almora\">Almora<\/option><option value=\"Dehra Dun\">Dehra Dun<\/option><option value=\"Haridwar\">Haridwar<\/option><option value=\"Mussoorie\">Mussoorie<\/option><option value=\"Nainital\">Nainital<\/option><option value=\"Pithoragarh\">Pithoragarh<\/option><option value=\"Alipore\">Alipore<\/option><option value=\"Alipur Duar\">Alipur Duar<\/option><option value=\"Asansol\">Asansol<\/option><option value=\"Baharampur\">Baharampur<\/option><option value=\"Bally\">Bally<\/option><option value=\"Balurghat\">Balurghat<\/option><option value=\"Bankura\">Bankura<\/option><option value=\"Baranagar\">Baranagar<\/option><option value=\"Barasat\">Barasat<\/option><option value=\"Barrackpore\">Barrackpore<\/option><option value=\"Basirhat\">Basirhat<\/option><option value=\"Bhatpara\">Bhatpara<\/option><option value=\"Bishnupur\">Bishnupur<\/option><option value=\"Budge Budge\">Budge Budge<\/option><option value=\"Burdwan\">Burdwan<\/option><option value=\"Chandernagore\">Chandernagore<\/option><option value=\"Darjiling\">Darjiling<\/option><option value=\"Diamond Harbour\">Diamond Harbour<\/option><option value=\"Dum Dum\">Dum Dum<\/option><option value=\"Durgapur\">Durgapur<\/option><option value=\"Halisahar\">Halisahar<\/option><option value=\"Haora\">Haora<\/option><option value=\"Hugli\">Hugli<\/option><option value=\"Ingraj Bazar\">Ingraj Bazar<\/option><option value=\"Jalpaiguri\">Jalpaiguri<\/option><option value=\"Kalimpong\">Kalimpong<\/option><option value=\"Kamarhati\">Kamarhati<\/option><option value=\"Kanchrapara\">Kanchrapara<\/option><option value=\"Kharagpur\">Kharagpur<\/option><option value=\"Koch Bihar\">Koch Bihar<\/option><option value=\"Kolkata\">Kolkata<\/option><option value=\"Krishnanagar\">Krishnanagar<\/option><option value=\"Malda\">Malda<\/option><option value=\"Midnapore\">Midnapore<\/option><option value=\"Murshidabad\">Murshidabad<\/option><option value=\"Navadwip\">Navadwip<\/option><option value=\"Palashi\">Palashi<\/option><option value=\"Panihati\">Panihati<\/option><option value=\"Purulia\">Purulia<\/option><option value=\"Raiganj\">Raiganj<\/option><option value=\"Santipur\">Santipur<\/option><option value=\"Shantiniketan\">Shantiniketan<\/option><option value=\"Shrirampur\">Shrirampur<\/option><option value=\"Siliguri\">Siliguri<\/option><option value=\"Siuri\">Siuri<\/option><option value=\"Tamluk\">Tamluk<\/option><option value=\"Titagarh\">Titagarh<\/option><option value=\"Others Cities\">Others Cities<\/option><\/select><\/span><\/label>\n<\/p>\n<p>[group MentionCities]<br>\n<label><b>11A. Mention City Name: (If Your City\/Town not in above list) <\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-179mentioncity\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-179mentioncity\"><\/span><\/label><br>\n[\/group]\n<\/p>\n<p><label><b>12. Select Your District\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"District\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"District\"><option value=\"Select One\">Select One<\/option><option value=\"Nicobar\">Nicobar<\/option><option value=\"North Middle Andaman\">North Middle Andaman<\/option><option value=\"South Andaman\">South Andaman<\/option><option value=\"Anantapur\">Anantapur<\/option><option value=\"Chittoor\">Chittoor<\/option><option value=\"East Godavari\">East Godavari<\/option><option value=\"Alluri Sitarama Raju\">Alluri Sitarama Raju<\/option><option value=\"Anakapalli\">Anakapalli<\/option><option value=\"Annamaya\">Annamaya<\/option><option value=\"Bapatla\">Bapatla<\/option><option value=\"Eluru\">Eluru<\/option><option value=\"Guntur\">Guntur<\/option><option value=\"Kadapa\">Kadapa<\/option><option value=\"Kakinada\">Kakinada<\/option><option value=\"Konaseema\">Konaseema<\/option><option value=\"Krishna\">Krishna<\/option><option value=\"Kurnool\">Kurnool<\/option><option value=\"Manyam\">Manyam<\/option><option value=\"N T Rama Rao\">N T Rama Rao<\/option><option value=\"Nandyal\">Nandyal<\/option><option value=\"Nellore\">Nellore<\/option><option value=\"Palnadu\">Palnadu<\/option><option value=\"Prakasam\">Prakasam<\/option><option value=\"Sri Balaji\">Sri Balaji<\/option><option value=\"Sri Satya Sai\">Sri Satya Sai<\/option><option value=\"Srikakulam\">Srikakulam<\/option><option value=\"Visakhapatnam\">Visakhapatnam<\/option><option value=\"Vizianagaram\">Vizianagaram<\/option><option value=\"West Godavari\">West Godavari<\/option><option value=\"Anjaw\">Anjaw<\/option><option value=\"Central Siang\">Central Siang<\/option><option value=\"Changlang\">Changlang<\/option><option value=\"Dibang Valley\">Dibang Valley<\/option><option value=\"East Kameng\">East Kameng<\/option><option value=\"East Siang\">East Siang<\/option><option value=\"Kamle\">Kamle<\/option><option value=\"Kra Daadi\">Kra Daadi<\/option><option value=\"Kurung Kumey\">Kurung Kumey<\/option><option value=\"Lepa Rada\">Lepa Rada<\/option><option value=\"Lohit\">Lohit<\/option><option value=\"Longding\">Longding<\/option><option value=\"Lower Dibang Valley\">Lower Dibang Valley<\/option><option value=\"Lower Siang\">Lower Siang<\/option><option value=\"Lower Subansiri\">Lower Subansiri<\/option><option value=\"Namsai\">Namsai<\/option><option value=\"Pakke Kessang\">Pakke Kessang<\/option><option value=\"Papum Pare\">Papum Pare<\/option><option value=\"Shi Yomi\">Shi Yomi<\/option><option value=\"Tawang\">Tawang<\/option><option value=\"Tirap\">Tirap<\/option><option value=\"Upper Siang\">Upper Siang<\/option><option value=\"Upper Subansiri\">Upper Subansiri<\/option><option value=\"West Kameng\">West Kameng<\/option><option value=\"West Siang\">West Siang<\/option><option value=\"Bajali\">Bajali<\/option><option value=\"Baksa\">Baksa<\/option><option value=\"Barpeta\">Barpeta<\/option><option value=\"Biswanath\">Biswanath<\/option><option value=\"Bongaigaon\">Bongaigaon<\/option><option value=\"Cachar\">Cachar<\/option><option value=\"Charaideo\">Charaideo<\/option><option value=\"Chirang\">Chirang<\/option><option value=\"Darrang\">Darrang<\/option><option value=\"Dhemaji\">Dhemaji<\/option><option value=\"Dhubri\">Dhubri<\/option><option value=\"Dibrugarh\">Dibrugarh<\/option><option value=\"Dima Hasao\">Dima Hasao<\/option><option value=\"Goalpara\">Goalpara<\/option><option value=\"Golaghat\">Golaghat<\/option><option value=\"Hailakandi\">Hailakandi<\/option><option value=\"Hojai\">Hojai<\/option><option value=\"Jorhat\">Jorhat<\/option><option value=\"Kamrup\">Kamrup<\/option><option value=\"Kamrup Metropolitan\">Kamrup Metropolitan<\/option><option value=\"Karbi Anglong\">Karbi Anglong<\/option><option value=\"Karimganj\">Karimganj<\/option><option value=\"Kokrajhar\">Kokrajhar<\/option><option value=\"Lakhimpur\">Lakhimpur<\/option><option value=\"Majuli\">Majuli<\/option><option value=\"Morigaon\">Morigaon<\/option><option value=\"Nagaon\">Nagaon<\/option><option value=\"Nalbari\">Nalbari<\/option><option value=\"Sivasagar\">Sivasagar<\/option><option value=\"Sonitpur\">Sonitpur<\/option><option value=\"South Salmara-Mankachar\">South Salmara-Mankachar<\/option><option value=\"Tamulpur\">Tamulpur<\/option><option value=\"Tinsukia\">Tinsukia<\/option><option value=\"Udalguri\">Udalguri<\/option><option value=\"West Karbi Anglong\">West Karbi Anglong<\/option><option value=\"Araria\">Araria<\/option><option value=\"Arwal\">Arwal<\/option><option value=\"Aurangabad\">Aurangabad<\/option><option value=\"Banka\">Banka<\/option><option value=\"Begusarai\">Begusarai<\/option><option value=\"Bhagalpur\">Bhagalpur<\/option><option value=\"Bhojpur\">Bhojpur<\/option><option value=\"Buxar\">Buxar<\/option><option value=\"Darbhanga\">Darbhanga<\/option><option value=\"East Champaran\">East Champaran<\/option><option value=\"Gaya\">Gaya<\/option><option value=\"Gopalganj\">Gopalganj<\/option><option value=\"Jamui\">Jamui<\/option><option value=\"Jehanabad\">Jehanabad<\/option><option value=\"Kaimur\">Kaimur<\/option><option value=\"Katihar\">Katihar<\/option><option value=\"Khagaria\">Khagaria<\/option><option value=\"Kishanganj\">Kishanganj<\/option><option value=\"Lakhisarai\">Lakhisarai<\/option><option value=\"Madhepura\">Madhepura<\/option><option value=\"Madhubani\">Madhubani<\/option><option value=\"Munger\">Munger<\/option><option value=\"Muzaffarpur\">Muzaffarpur<\/option><option value=\"Nalanda\">Nalanda<\/option><option value=\"Nawada\">Nawada<\/option><option value=\"Patna\">Patna<\/option><option value=\"Purnia\">Purnia<\/option><option value=\"Rohtas\">Rohtas<\/option><option value=\"Saharsa\">Saharsa<\/option><option value=\"Samastipur\">Samastipur<\/option><option value=\"Saran\">Saran<\/option><option value=\"Sheikhpura\">Sheikhpura<\/option><option value=\"Sheohar\">Sheohar<\/option><option value=\"Sitamarhi\">Sitamarhi<\/option><option value=\"Siwan\">Siwan<\/option><option value=\"Supaul\">Supaul<\/option><option value=\"Vaishali\">Vaishali<\/option><option value=\"West Champaran\">West Champaran<\/option><option value=\"Chandigarh\">Chandigarh<\/option><option value=\"Balod\">Balod<\/option><option value=\"Baloda Bazar\">Baloda Bazar<\/option><option value=\"Balrampur\">Balrampur<\/option><option value=\"Bastar\">Bastar<\/option><option value=\"Bemetara\">Bemetara<\/option><option value=\"Bijapur\">Bijapur<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Dantewada\">Dantewada<\/option><option value=\"Dhamtari\">Dhamtari<\/option><option value=\"Durg\">Durg<\/option><option value=\"Gariaband\">Gariaband<\/option><option value=\"Gaurela Pendra Marwahi\">Gaurela Pendra Marwahi<\/option><option value=\"Janjgir Champa\">Janjgir Champa<\/option><option value=\"Jashpur\">Jashpur<\/option><option value=\"Kabirdham\">Kabirdham<\/option><option value=\"Kanker\">Kanker<\/option><option value=\"Khairagarh\">Khairagarh<\/option><option value=\"Kondagaon\">Kondagaon<\/option><option value=\"Korba\">Korba<\/option><option value=\"Koriya\">Koriya<\/option><option value=\"Mahasamund\">Mahasamund<\/option><option value=\"Manendragarh\">Manendragarh<\/option><option value=\"Mohla Manpur\">Mohla Manpur<\/option><option value=\"Mungeli\">Mungeli<\/option><option value=\"Narayanpur\">Narayanpur<\/option><option value=\"Raigarh\">Raigarh<\/option><option value=\"Raipur\">Raipur<\/option><option value=\"Rajnandgaon\">Rajnandgaon<\/option><option value=\"Sakti\">Sakti<\/option><option value=\"Sarangarh Bilaigarh\">Sarangarh Bilaigarh<\/option><option value=\"Sukma\">Sukma<\/option><option value=\"Surajpur\">Surajpur<\/option><option value=\"Surguja\">Surguja<\/option><option value=\"Dadra and Nagar Haveli\">Dadra and Nagar Haveli<\/option><option value=\"Daman\">Daman<\/option><option value=\"Diu\">Diu<\/option><option value=\"Central Delhi\">Central Delhi<\/option><option value=\"East Delhi\">East Delhi<\/option><option value=\"New Delhi\">New Delhi<\/option><option value=\"North Delhi\">North Delhi<\/option><option value=\"North East Delhi\">North East Delhi<\/option><option value=\"North West Delhi\">North West Delhi<\/option><option value=\"Shahdara\">Shahdara<\/option><option value=\"South Delhi\">South Delhi<\/option><option value=\"South East Delhi\">South East Delhi<\/option><option value=\"South West Delhi\">South West Delhi<\/option><option value=\"West Delhi\">West Delhi<\/option><option value=\"North Goa\">North Goa<\/option><option value=\"South Goa\">South Goa<\/option><option value=\"Ahmedabad\">Ahmedabad<\/option><option value=\"Amreli\">Amreli<\/option><option value=\"Anand\">Anand<\/option><option value=\"Aravalli\">Aravalli<\/option><option value=\"Banaskantha\">Banaskantha<\/option><option value=\"Bharuch\">Bharuch<\/option><option value=\"Bhavnagar\">Bhavnagar<\/option><option value=\"Botad\">Botad<\/option><option value=\"Chhota Udaipur\">Chhota Udaipur<\/option><option value=\"Dahod\">Dahod<\/option><option value=\"Dang\">Dang<\/option><option value=\"Devbhoomi Dwarka\">Devbhoomi Dwarka<\/option><option value=\"Gandhinagar\">Gandhinagar<\/option><option value=\"Gir Somnath\">Gir Somnath<\/option><option value=\"Jamnagar\">Jamnagar<\/option><option value=\"Junagadh\">Junagadh<\/option><option value=\"Kheda\">Kheda<\/option><option value=\"Kutch\">Kutch<\/option><option value=\"Mahisagar\">Mahisagar<\/option><option value=\"Mehsana\">Mehsana<\/option><option value=\"Morbi\">Morbi<\/option><option value=\"Narmada\">Narmada<\/option><option value=\"Navsari\">Navsari<\/option><option value=\"Panchmahal\">Panchmahal<\/option><option value=\"Patan\">Patan<\/option><option value=\"Porbandar\">Porbandar<\/option><option value=\"Rajkot\">Rajkot<\/option><option value=\"Sabarkantha\">Sabarkantha<\/option><option value=\"Surat\">Surat<\/option><option value=\"Surendranagar\">Surendranagar<\/option><option value=\"Tapi\">Tapi<\/option><option value=\"Vadodara\">Vadodara<\/option><option value=\"Valsad\">Valsad<\/option><option value=\"Ambala\">Ambala<\/option><option value=\"Bhiwani\">Bhiwani<\/option><option value=\"Charkhi Dadri\">Charkhi Dadri<\/option><option value=\"Faridabad\">Faridabad<\/option><option value=\"Fatehabad\">Fatehabad<\/option><option value=\"Gurugram\">Gurugram<\/option><option value=\"Hisar\">Hisar<\/option><option value=\"Jhajjar\">Jhajjar<\/option><option value=\"Jind\">Jind<\/option><option value=\"Kaithal\">Kaithal<\/option><option value=\"Karnal\">Karnal<\/option><option value=\"Kurukshetra\">Kurukshetra<\/option><option value=\"Mahendragarh\">Mahendragarh<\/option><option value=\"Mewat\">Mewat<\/option><option value=\"Palwal\">Palwal<\/option><option value=\"Panchkula\">Panchkula<\/option><option value=\"Panipat\">Panipat<\/option><option value=\"Rewari\">Rewari<\/option><option value=\"Rohtak\">Rohtak<\/option><option value=\"Sirsa\">Sirsa<\/option><option value=\"Sonipat\">Sonipat<\/option><option value=\"Yamunanagar\">Yamunanagar<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Chamba\">Chamba<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Kangra\">Kangra<\/option><option value=\"Kinnaur\">Kinnaur<\/option><option value=\"Kullu\">Kullu<\/option><option value=\"Lahaul Spiti\">Lahaul Spiti<\/option><option value=\"Mandi\">Mandi<\/option><option value=\"Shimla\">Shimla<\/option><option value=\"Sirmaur\">Sirmaur<\/option><option value=\"Solan\">Solan<\/option><option value=\"Una\">Una<\/option><option value=\"Anantnag\">Anantnag<\/option><option value=\"Bandipora\">Bandipora<\/option><option value=\"Baramulla\">Baramulla<\/option><option value=\"Budgam\">Budgam<\/option><option value=\"Doda\">Doda<\/option><option value=\"Ganderbal\">Ganderbal<\/option><option value=\"Jammu\">Jammu<\/option><option value=\"Kathua\">Kathua<\/option><option value=\"Kishtwar\">Kishtwar<\/option><option value=\"Kulgam\">Kulgam<\/option><option value=\"Kupwara\">Kupwara<\/option><option value=\"Poonch\">Poonch<\/option><option value=\"Pulwama\">Pulwama<\/option><option value=\"Rajouri\">Rajouri<\/option><option value=\"Ramban\">Ramban<\/option><option value=\"Reasi\">Reasi<\/option><option value=\"Samba\">Samba<\/option><option value=\"Shopian\">Shopian<\/option><option value=\"Srinagar\">Srinagar<\/option><option value=\"Udhampur\">Udhampur<\/option><option value=\"Bokaro\">Bokaro<\/option><option value=\"Chatra\">Chatra<\/option><option value=\"Deoghar\">Deoghar<\/option><option value=\"Dhanbad\">Dhanbad<\/option><option value=\"Dumka\">Dumka<\/option><option value=\"East Singhbhum\">East Singhbhum<\/option><option value=\"Garhwa\">Garhwa<\/option><option value=\"Giridih\">Giridih<\/option><option value=\"Godda\">Godda<\/option><option value=\"Gumla\">Gumla<\/option><option value=\"Hazaribagh\">Hazaribagh<\/option><option value=\"Jamtara\">Jamtara<\/option><option value=\"Khunti\">Khunti<\/option><option value=\"Koderma\">Koderma<\/option><option value=\"Latehar\">Latehar<\/option><option value=\"Lohardaga\">Lohardaga<\/option><option value=\"Pakur\">Pakur<\/option><option value=\"Palamu\">Palamu<\/option><option value=\"Ramgarh\">Ramgarh<\/option><option value=\"Ranchi\">Ranchi<\/option><option value=\"Sahebganj\">Sahebganj<\/option><option value=\"Seraikela Kharsawan\">Seraikela Kharsawan<\/option><option value=\"Simdega\">Simdega<\/option><option value=\"West Singhbhum\">West Singhbhum<\/option><option value=\"Bagalkot\">Bagalkot<\/option><option value=\"Bangalore Rural\">Bangalore Rural<\/option><option value=\"Bangalore Urban\">Bangalore Urban<\/option><option value=\"Belgaum\">Belgaum<\/option><option value=\"Bellary\">Bellary<\/option><option value=\"Bidar\">Bidar<\/option><option value=\"Chamarajanagar\">Chamarajanagar<\/option><option value=\"Chikkaballapur\">Chikkaballapur<\/option><option value=\"Chikkamagaluru\">Chikkamagaluru<\/option><option value=\"Chitradurga\">Chitradurga<\/option><option value=\"Dakshina Kannada\">Dakshina Kannada<\/option><option value=\"Davanagere\">Davanagere<\/option><option value=\"Dharwad\">Dharwad<\/option><option value=\"Gadag\">Gadag<\/option><option value=\"Gulbarga\">Gulbarga<\/option><option value=\"Hassan\">Hassan<\/option><option value=\"Haveri\">Haveri<\/option><option value=\"Kodagu\">Kodagu<\/option><option value=\"Kolar\">Kolar<\/option><option value=\"Koppal\">Koppal<\/option><option value=\"Mandya\">Mandya<\/option><option value=\"Mysore\">Mysore<\/option><option value=\"Raichur\">Raichur<\/option><option value=\"Ramanagara\">Ramanagara<\/option><option value=\"Shimoga\">Shimoga<\/option><option value=\"Tumkur\">Tumkur<\/option><option value=\"Udupi\">Udupi<\/option><option value=\"Uttara Kannada\">Uttara Kannada<\/option><option value=\"Vijayanagara\">Vijayanagara<\/option><option value=\"Vijayapura\">Vijayapura<\/option><option value=\"Yadgir\">Yadgir<\/option><option value=\"Alappuzha\">Alappuzha<\/option><option value=\"Ernakulam\">Ernakulam<\/option><option value=\"Idukki\">Idukki<\/option><option value=\"Kannur\">Kannur<\/option><option value=\"Kasaragod\">Kasaragod<\/option><option value=\"Kollam\">Kollam<\/option><option value=\"Kottayam\">Kottayam<\/option><option value=\"Kozhikode\">Kozhikode<\/option><option value=\"Malappuram\">Malappuram<\/option><option value=\"Palakkad\">Palakkad<\/option><option value=\"Pathanamthitta\">Pathanamthitta<\/option><option value=\"Thiruvananthapuram\">Thiruvananthapuram<\/option><option value=\"Thrissur\">Thrissur<\/option><option value=\"Wayanad\">Wayanad<\/option><option value=\"Kargil\">Kargil<\/option><option value=\"Leh\">Leh<\/option><option value=\"Lakshadweep\">Lakshadweep<\/option><option value=\"Agar Malwa\">Agar Malwa<\/option><option value=\"Alirajpur\">Alirajpur<\/option><option value=\"Anuppur\">Anuppur<\/option><option value=\"Ashoknagar\">Ashoknagar<\/option><option value=\"Balaghat\">Balaghat<\/option><option value=\"Barwani\">Barwani<\/option><option value=\"Betul\">Betul<\/option><option value=\"Bhind\">Bhind<\/option><option value=\"Bhopal\">Bhopal<\/option><option value=\"Burhanpur\">Burhanpur<\/option><option value=\"Chachaura\">Chachaura<\/option><option value=\"Chhatarpur\">Chhatarpur<\/option><option value=\"Chhindwara\">Chhindwara<\/option><option value=\"Damoh\">Damoh<\/option><option value=\"Datia\">Datia<\/option><option value=\"Dewas\">Dewas<\/option><option value=\"Dhar\">Dhar<\/option><option value=\"Dindori\">Dindori<\/option><option value=\"Guna\">Guna<\/option><option value=\"Gwalior\">Gwalior<\/option><option value=\"Harda\">Harda<\/option><option value=\"Hoshangabad\">Hoshangabad<\/option><option value=\"Indore\">Indore<\/option><option value=\"Jabalpur\">Jabalpur<\/option><option value=\"Jhabua\">Jhabua<\/option><option value=\"Katni\">Katni<\/option><option value=\"Khandwa\">Khandwa<\/option><option value=\"Khargone\">Khargone<\/option><option value=\"Maihar\">Maihar<\/option><option value=\"Mandla\">Mandla<\/option><option value=\"Mandsaur\">Mandsaur<\/option><option value=\"Morena\">Morena<\/option><option value=\"Nagda\">Nagda<\/option><option value=\"Narsinghpur\">Narsinghpur<\/option><option value=\"Neemuch\">Neemuch<\/option><option value=\"Niwari\">Niwari<\/option><option value=\"Panna\">Panna<\/option><option value=\"Raisen\">Raisen<\/option><option value=\"Rajgarh\">Rajgarh<\/option><option value=\"Ratlam\">Ratlam<\/option><option value=\"Rewa\">Rewa<\/option><option value=\"Sagar\">Sagar<\/option><option value=\"Satna\">Satna<\/option><option value=\"Sehore\">Sehore<\/option><option value=\"Seoni\">Seoni<\/option><option value=\"Shahdol\">Shahdol<\/option><option value=\"Shajapur\">Shajapur<\/option><option value=\"Sheopur\">Sheopur<\/option><option value=\"Shivpuri\">Shivpuri<\/option><option value=\"Sidhi\">Sidhi<\/option><option value=\"Singrauli\">Singrauli<\/option><option value=\"Tikamgarh\">Tikamgarh<\/option><option value=\"Ujjain\">Ujjain<\/option><option value=\"Umaria\">Umaria<\/option><option value=\"Vidisha\">Vidisha<\/option><option value=\"Ahmednagar\">Ahmednagar<\/option><option value=\"Akola\">Akola<\/option><option value=\"Amravati\">Amravati<\/option><option value=\"Aurangabad\">Aurangabad<\/option><option value=\"Beed\">Beed<\/option><option value=\"Bhandara\">Bhandara<\/option><option value=\"Buldhana\">Buldhana<\/option><option value=\"Chandrapur\">Chandrapur<\/option><option value=\"Dhule\">Dhule<\/option><option value=\"Gadchiroli\">Gadchiroli<\/option><option value=\"Gondia\">Gondia<\/option><option value=\"Hingoli\">Hingoli<\/option><option value=\"Jalgaon\">Jalgaon<\/option><option value=\"Jalna\">Jalna<\/option><option value=\"Kolhapur\">Kolhapur<\/option><option value=\"Latur\">Latur<\/option><option value=\"Mumbai City\">Mumbai City<\/option><option value=\"Mumbai Suburban\">Mumbai Suburban<\/option><option value=\"Nagpur\">Nagpur<\/option><option value=\"Nanded\">Nanded<\/option><option value=\"Nandurbar\">Nandurbar<\/option><option value=\"Nashik\">Nashik<\/option><option value=\"Osmanabad\">Osmanabad<\/option><option value=\"Palghar\">Palghar<\/option><option value=\"Parbhani\">Parbhani<\/option><option value=\"Pune\">Pune<\/option><option value=\"Raigad\">Raigad<\/option><option value=\"Ratnagiri\">Ratnagiri<\/option><option value=\"Sangli\">Sangli<\/option><option value=\"Satara\">Satara<\/option><option value=\"Sindhudurg\">Sindhudurg<\/option><option value=\"Solapur\">Solapur<\/option><option value=\"Thane\">Thane<\/option><option value=\"Wardha\">Wardha<\/option><option value=\"Washim\">Washim<\/option><option value=\"Yavatmal\">Yavatmal<\/option><option value=\"Bishnupur\">Bishnupur<\/option><option value=\"Chandel\">Chandel<\/option><option value=\"Churachandpur\">Churachandpur<\/option><option value=\"Imphal East\">Imphal East<\/option><option value=\"Imphal West\">Imphal West<\/option><option value=\"Jiribam\">Jiribam<\/option><option value=\"Kakching\">Kakching<\/option><option value=\"Kamjong\">Kamjong<\/option><option value=\"Kangpokpi\">Kangpokpi<\/option><option value=\"Noney\">Noney<\/option><option value=\"Pherzawl\">Pherzawl<\/option><option value=\"Senapati\">Senapati<\/option><option value=\"Tamenglong\">Tamenglong<\/option><option value=\"Tengnoupal\">Tengnoupal<\/option><option value=\"Thoubal\">Thoubal<\/option><option value=\"Ukhrul\">Ukhrul<\/option><option value=\"East Garo Hills\">East Garo Hills<\/option><option value=\"East Jaintia Hills\">East Jaintia Hills<\/option><option value=\"East Khasi Hills\">East Khasi Hills<\/option><option value=\"Mairang\">Mairang<\/option><option value=\"North Garo Hills\">North Garo Hills<\/option><option value=\"Ri Bhoi\">Ri Bhoi<\/option><option value=\"South Garo Hills\">South Garo Hills<\/option><option value=\"South West Garo Hills\">South West Garo Hills<\/option><option value=\"South West Khasi Hills\">South West Khasi Hills<\/option><option value=\"West Garo Hills\">West Garo Hills<\/option><option value=\"West Jaintia Hills\">West Jaintia Hills<\/option><option value=\"West Khasi Hills\">West Khasi Hills<\/option><option value=\"Aizawl\">Aizawl<\/option><option value=\"Champhai\">Champhai<\/option><option value=\"Hnahthial\">Hnahthial<\/option><option value=\"Kolasib\">Kolasib<\/option><option value=\"Khawzawl\">Khawzawl<\/option><option value=\"Lawngtlai\">Lawngtlai<\/option><option value=\"Lunglei\">Lunglei<\/option><option value=\"Mamit\">Mamit<\/option><option value=\"Saiha\">Saiha<\/option><option value=\"Serchhip\">Serchhip<\/option><option value=\"Saitual\">Saitual<\/option><option value=\"Chumukedima\">Chumukedima<\/option><option value=\"Dimapur\">Dimapur<\/option><option value=\"Kiphire\">Kiphire<\/option><option value=\"Kohima\">Kohima<\/option><option value=\"Longleng\">Longleng<\/option><option value=\"Mokokchung\">Mokokchung<\/option><option value=\"Mon\">Mon<\/option><option value=\"Niuland\">Niuland<\/option><option value=\"Noklak\">Noklak<\/option><option value=\"Peren\">Peren<\/option><option value=\"Phek\">Phek<\/option><option value=\"Shamator\">Shamator<\/option><option value=\"Tseminyu\">Tseminyu<\/option><option value=\"Tuensang\">Tuensang<\/option><option value=\"Wokha\">Wokha<\/option><option value=\"Zunheboto\">Zunheboto<\/option><option value=\"Angul\">Angul<\/option><option value=\"Balangir\">Balangir<\/option><option value=\"Balasore\">Balasore<\/option><option value=\"Bargarh\">Bargarh<\/option><option value=\"Bhadrak\">Bhadrak<\/option><option value=\"Boudh\">Boudh<\/option><option value=\"Cuttack\">Cuttack<\/option><option value=\"Debagarh\">Debagarh<\/option><option value=\"Dhenkanal\">Dhenkanal<\/option><option value=\"Gajapati\">Gajapati<\/option><option value=\"Ganjam\">Ganjam<\/option><option value=\"Jagatsinghpur\">Jagatsinghpur<\/option><option value=\"Jajpur\">Jajpur<\/option><option value=\"Jharsuguda\">Jharsuguda<\/option><option value=\"Kalahandi\">Kalahandi<\/option><option value=\"Kandhamal\">Kandhamal<\/option><option value=\"Kendrapara\">Kendrapara<\/option><option value=\"Kendujhar\">Kendujhar<\/option><option value=\"Khordha\">Khordha<\/option><option value=\"Koraput\">Koraput<\/option><option value=\"Malkangiri\">Malkangiri<\/option><option value=\"Mayurbhanj\">Mayurbhanj<\/option><option value=\"Nabarangpur\">Nabarangpur<\/option><option value=\"Nayagarh\">Nayagarh<\/option><option value=\"Nuapada\">Nuapada<\/option><option value=\"Puri\">Puri<\/option><option value=\"Rayagada\">Rayagada<\/option><option value=\"Sambalpur\">Sambalpur<\/option><option value=\"Subarnapur\">Subarnapur<\/option><option value=\"Sundergarh\">Sundergarh<\/option><option value=\"Karaikal\">Karaikal<\/option><option value=\"Mahe\">Mahe<\/option><option value=\"Puducherry\">Puducherry<\/option><option value=\"Yanam\">Yanam<\/option><option value=\"Amritsar\">Amritsar<\/option><option value=\"Barnala\">Barnala<\/option><option value=\"Bathinda\">Bathinda<\/option><option value=\"Faridkot\">Faridkot<\/option><option value=\"Fatehgarh Sahib\">Fatehgarh Sahib<\/option><option value=\"Fazilka\">Fazilka<\/option><option value=\"Firozpur\">Firozpur<\/option><option value=\"Gurdaspur\">Gurdaspur<\/option><option value=\"Hoshiarpur\">Hoshiarpur<\/option><option value=\"Jalandhar\">Jalandhar<\/option><option value=\"Kapurthala\">Kapurthala<\/option><option value=\"Ludhiana\">Ludhiana<\/option><option value=\"Malerkotla\">Malerkotla<\/option><option value=\"Mansa\">Mansa<\/option><option value=\"Moga\">Moga<\/option><option value=\"Mohali\">Mohali<\/option><option value=\"Muktsar\">Muktsar<\/option><option value=\"Pathankot\">Pathankot<\/option><option value=\"Patiala\">Patiala<\/option><option value=\"Rupnagar\">Rupnagar<\/option><option value=\"Sangrur\">Sangrur<\/option><option value=\"Shaheed Bhagat Singh Nagar\">Shaheed Bhagat Singh Nagar<\/option><option value=\"Tarn Taran\">Tarn Taran<\/option><option value=\"Ajmer\">Ajmer<\/option><option value=\"Alwar\">Alwar<\/option><option value=\"Banswara\">Banswara<\/option><option value=\"Baran\">Baran<\/option><option value=\"Barmer\">Barmer<\/option><option value=\"Bharatpur\">Bharatpur<\/option><option value=\"Bhilwara\">Bhilwara<\/option><option value=\"Bikaner\">Bikaner<\/option><option value=\"Bundi\">Bundi<\/option><option value=\"Chittorgarh\">Chittorgarh<\/option><option value=\"Churu\">Churu<\/option><option value=\"Dausa\">Dausa<\/option><option value=\"Dholpur\">Dholpur<\/option><option value=\"Dungarpur\">Dungarpur<\/option><option value=\"Hanumangarh\">Hanumangarh<\/option><option value=\"Jaipur\">Jaipur<\/option><option value=\"Jaisalmer\">Jaisalmer<\/option><option value=\"Jalore\">Jalore<\/option><option value=\"Jhalawar\">Jhalawar<\/option><option value=\"Jhunjhunu\">Jhunjhunu<\/option><option value=\"Jodhpur\">Jodhpur<\/option><option value=\"Karauli\">Karauli<\/option><option value=\"Kota\">Kota<\/option><option value=\"Nagaur\">Nagaur<\/option><option value=\"Pali\">Pali<\/option><option value=\"Pratapgarh\">Pratapgarh<\/option><option value=\"Rajsamand\">Rajsamand<\/option><option value=\"Sawai Madhopur\">Sawai Madhopur<\/option><option value=\"Sikar\">Sikar<\/option><option value=\"Sirohi\">Sirohi<\/option><option value=\"Sri Ganganagar\">Sri Ganganagar<\/option><option value=\"Tonk\">Tonk<\/option><option value=\"Udaipur\">Udaipur<\/option><option value=\"East Sikkim\">East Sikkim<\/option><option value=\"North Sikkim\">North Sikkim<\/option><option value=\"Pakyong\">Pakyong<\/option><option value=\"Soreng\">Soreng<\/option><option value=\"South Sikkim\">South Sikkim<\/option><option value=\"West Sikkim\">West Sikkim<\/option><option value=\"Ariyalur\">Ariyalur<\/option><option value=\"Chengalpattu\">Chengalpattu<\/option><option value=\"Chennai\">Chennai<\/option><option value=\"Coimbatore\">Coimbatore<\/option><option value=\"Cuddalore\">Cuddalore<\/option><option value=\"Dharmapuri\">Dharmapuri<\/option><option value=\"Dindigul\">Dindigul<\/option><option value=\"Erode\">Erode<\/option><option value=\"Kallakurichi\">Kallakurichi<\/option><option value=\"Kanchipuram\">Kanchipuram<\/option><option value=\"Kanyakumari\">Kanyakumari<\/option><option value=\"Karur\">Karur<\/option><option value=\"Krishnagiri\">Krishnagiri<\/option><option value=\"Madurai\">Madurai<\/option><option value=\"Mayiladuthurai\">Mayiladuthurai<\/option><option value=\"Nagapattinam\">Nagapattinam<\/option><option value=\"Namakkal\">Namakkal<\/option><option value=\"Nilgiris\">Nilgiris<\/option><option value=\"Perambalur\">Perambalur<\/option><option value=\"Pudukkottai\">Pudukkottai<\/option><option value=\"Ramanathapuram\">Ramanathapuram<\/option><option value=\"Ranipet\">Ranipet<\/option><option value=\"Salem\">Salem<\/option><option value=\"Sivaganga\">Sivaganga<\/option><option value=\"Tenkasi\">Tenkasi<\/option><option value=\"Thanjavur\">Thanjavur<\/option><option value=\"Theni\">Theni<\/option><option value=\"Thoothukudi\">Thoothukudi<\/option><option value=\"Tiruchirappalli\">Tiruchirappalli<\/option><option value=\"Tirunelveli\">Tirunelveli<\/option><option value=\"Tirupattur\">Tirupattur<\/option><option value=\"Tiruppur\">Tiruppur<\/option><option value=\"Tiruvallur\">Tiruvallur<\/option><option value=\"Tiruvannamalai\">Tiruvannamalai<\/option><option value=\"Tiruvarur\">Tiruvarur<\/option><option value=\"Vellore\">Vellore<\/option><option value=\"Viluppuram\">Viluppuram<\/option><option value=\"Virudhunagar\">Virudhunagar<\/option><option value=\"Adilabad\">Adilabad<\/option><option value=\"Bhadradri Kothagudem\">Bhadradri Kothagudem<\/option><option value=\"Hyderabad\">Hyderabad<\/option><option value=\"Jagtial\">Jagtial<\/option><option value=\"Jangaon\">Jangaon<\/option><option value=\"Jayashankar\">Jayashankar<\/option><option value=\"Jogulamba\">Jogulamba<\/option><option value=\"Kamareddy\">Kamareddy<\/option><option value=\"Karimnagar\">Karimnagar<\/option><option value=\"Khammam\">Khammam<\/option><option value=\"Komaram Bheem\">Komaram Bheem<\/option><option value=\"Mahabubabad\">Mahabubabad<\/option><option value=\"Mahbubnagar\">Mahbubnagar<\/option><option value=\"Mancherial\">Mancherial<\/option><option value=\"Medak\">Medak<\/option><option value=\"Medchal\">Medchal<\/option><option value=\"Mulugu\">Mulugu<\/option><option value=\"Nagarkurnool\">Nagarkurnool<\/option><option value=\"Nalgonda\">Nalgonda<\/option><option value=\"Narayanpet\">Narayanpet<\/option><option value=\"Nirmal\">Nirmal<\/option><option value=\"Nizamabad\">Nizamabad<\/option><option value=\"Peddapalli\">Peddapalli<\/option><option value=\"Rajanna Sircilla\">Rajanna Sircilla<\/option><option value=\"Ranga Reddy\">Ranga Reddy<\/option><option value=\"Sangareddy\">Sangareddy<\/option><option value=\"Siddipet\">Siddipet<\/option><option value=\"Suryapet\">Suryapet<\/option><option value=\"Vikarabad\">Vikarabad<\/option><option value=\"Wanaparthy\">Wanaparthy<\/option><option value=\"Warangal\">Warangal<\/option><option value=\"Hanamkonda\">Hanamkonda<\/option><option value=\"Yadadri Bhuvanagiri\">Yadadri Bhuvanagiri<\/option><option value=\"Dhalai\">Dhalai<\/option><option value=\"Gomati\">Gomati<\/option><option value=\"Khowai\">Khowai<\/option><option value=\"North Tripura\">North Tripura<\/option><option value=\"Sepahijala\">Sepahijala<\/option><option value=\"South Tripura\">South Tripura<\/option><option value=\"Unakoti\">Unakoti<\/option><option value=\"West Tripura\">West Tripura<\/option><option value=\"Agra\">Agra<\/option><option value=\"Aligarh\">Aligarh<\/option><option value=\"Ambedkar Nagar\">Ambedkar Nagar<\/option><option value=\"Amethi\">Amethi<\/option><option value=\"Amroha\">Amroha<\/option><option value=\"Auraiya\">Auraiya<\/option><option value=\"Ayodhya\">Ayodhya<\/option><option value=\"Azamgarh\">Azamgarh<\/option><option value=\"Baghpat\">Baghpat<\/option><option value=\"Bahraich\">Bahraich<\/option><option value=\"Ballia\">Ballia<\/option><option value=\"Balrampur\">Balrampur<\/option><option value=\"Banda\">Banda<\/option><option value=\"Barabanki\">Barabanki<\/option><option value=\"Bareilly\">Bareilly<\/option><option value=\"Basti\">Basti<\/option><option value=\"Bhadohi\">Bhadohi<\/option><option value=\"Bijnor\">Bijnor<\/option><option value=\"Budaun\">Budaun<\/option><option value=\"Bulandshahr\">Bulandshahr<\/option><option value=\"Chandauli\">Chandauli<\/option><option value=\"Chitrakoot\">Chitrakoot<\/option><option value=\"Deoria\">Deoria<\/option><option value=\"Etah\">Etah<\/option><option value=\"Etawah\">Etawah<\/option><option value=\"Farrukhabad\">Farrukhabad<\/option><option value=\"Fatehpur\">Fatehpur<\/option><option value=\"Firozabad\">Firozabad<\/option><option value=\"Gautam Buddha Nagar\">Gautam Buddha Nagar<\/option><option value=\"Ghaziabad\">Ghaziabad<\/option><option value=\"Ghazipur\">Ghazipur<\/option><option value=\"Gonda\">Gonda<\/option><option value=\"Gorakhpur\">Gorakhpur<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Hapur\">Hapur<\/option><option value=\"Hardoi\">Hardoi<\/option><option value=\"Hathras\">Hathras<\/option><option value=\"Jalaun\">Jalaun<\/option><option value=\"Jaunpur\">Jaunpur<\/option><option value=\"Jhansi\">Jhansi<\/option><option value=\"Kannauj\">Kannauj<\/option><option value=\"Kanpur Dehat\">Kanpur Dehat<\/option><option value=\"Kanpur Nagar\">Kanpur Nagar<\/option><option value=\"Kasganj\">Kasganj<\/option><option value=\"Kaushambi\">Kaushambi<\/option><option value=\"Kheri\">Kheri<\/option><option value=\"Kushinagar\">Kushinagar<\/option><option value=\"Lalitpur\">Lalitpur<\/option><option value=\"Lucknow\">Lucknow<\/option><option value=\"Maharajganj\">Maharajganj<\/option><option value=\"Mahoba\">Mahoba<\/option><option value=\"Mainpuri\">Mainpuri<\/option><option value=\"Mathura\">Mathura<\/option><option value=\"Mau\">Mau<\/option><option value=\"Meerut\">Meerut<\/option><option value=\"Mirzapur\">Mirzapur<\/option><option value=\"Moradabad\">Moradabad<\/option><option value=\"Muzaffarnagar\">Muzaffarnagar<\/option><option value=\"Pilibhit\">Pilibhit<\/option><option value=\"Pratapgarh\">Pratapgarh<\/option><option value=\"Prayagraj\">Prayagraj<\/option><option value=\"Raebareli\">Raebareli<\/option><option value=\"Rampur\">Rampur<\/option><option value=\"Saharanpur\">Saharanpur<\/option><option value=\"Sambhal\">Sambhal<\/option><option value=\"Sant Kabir Nagar\">Sant Kabir Nagar<\/option><option value=\"Shahjahanpur\">Shahjahanpur<\/option><option value=\"Shamli\">Shamli<\/option><option value=\"Shravasti\">Shravasti<\/option><option value=\"Siddharthnagar\">Siddharthnagar<\/option><option value=\"Sitapur\">Sitapur<\/option><option value=\"Sonbhadra\">Sonbhadra<\/option><option value=\"Sultanpur\">Sultanpur<\/option><option value=\"Unnao\">Unnao<\/option><option value=\"Varanasi\">Varanasi<\/option><option value=\"Almora\">Almora<\/option><option value=\"Bageshwar\">Bageshwar<\/option><option value=\"Chamoli\">Chamoli<\/option><option value=\"Champawat\">Champawat<\/option><option value=\"Dehradun\">Dehradun<\/option><option value=\"Haridwar\">Haridwar<\/option><option value=\"Nainital\">Nainital<\/option><option value=\"Pauri\">Pauri<\/option><option value=\"Pithoragarh\">Pithoragarh<\/option><option value=\"Rudraprayag\">Rudraprayag<\/option><option value=\"Tehri\">Tehri<\/option><option value=\"Udham Singh Nagar\">Udham Singh Nagar<\/option><option value=\"Uttarkashi\">Uttarkashi<\/option><option value=\"Alipurduar\">Alipurduar<\/option><option value=\"Bankura\">Bankura<\/option><option value=\"Birbhum\">Birbhum<\/option><option value=\"Cooch Behar\">Cooch Behar<\/option><option value=\"Dakshin Dinajpur\">Dakshin Dinajpur<\/option><option value=\"Darjeeling\">Darjeeling<\/option><option value=\"Hooghly\">Hooghly<\/option><option value=\"Howrah\">Howrah<\/option><option value=\"Jalpaiguri\">Jalpaiguri<\/option><option value=\"Jhargram\">Jhargram<\/option><option value=\"Kalimpong\">Kalimpong<\/option><option value=\"Kolkata\">Kolkata<\/option><option value=\"Malda\">Malda<\/option><option value=\"Murshidabad\">Murshidabad<\/option><option value=\"Nadia\">Nadia<\/option><option value=\"North 24 Parganas\">North 24 Parganas<\/option><option value=\"Paschim Bardhaman\">Paschim Bardhaman<\/option><option value=\"Paschim Medinipur\">Paschim Medinipur<\/option><option value=\"Purba Bardhaman\">Purba Bardhaman<\/option><option value=\"Purba Medinipur\">Purba Medinipur<\/option><option value=\"Purulia\">Purulia<\/option><option value=\"South 24 Parganas\">South 24 Parganas<\/option><option value=\"Uttar Dinajpur\">Uttar Dinajpur<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> <b> 13.Update Your Bank details (Select Your Bank)\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SelectyourBank\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"SelectyourBank\"><option value=\"Select One\">Select One<\/option><option value=\"Allahabad Bank\">Allahabad Bank<\/option><option value=\"Andhra Bank\">Andhra Bank<\/option><option value=\"Axis Bank\">Axis Bank<\/option><option value=\"Bank of Bahrain and Kuwait\">Bank of Bahrain and Kuwait<\/option><option value=\"Bank of Baroda - Corporate Banking\">Bank of Baroda \u2013 Corporate Banking<\/option><option value=\"Bank of Baroda - Retail Banking\">Bank of Baroda \u2013 Retail Banking<\/option><option value=\"Bank of India\">Bank of India<\/option><option value=\"Bank of Maharashtra\">Bank of Maharashtra<\/option><option value=\"Canara Bank\">Canara Bank<\/option><option value=\"Central Bank of India\">Central Bank of India<\/option><option value=\"City Union Bank\">City Union Bank<\/option><option value=\"Corporation Bank\">Corporation Bank<\/option><option value=\"Deutsche Bank\">Deutsche Bank<\/option><option value=\"Development Credit Bank\">Development Credit Bank<\/option><option value=\"Dhanlaxmi Bank\">Dhanlaxmi Bank<\/option><option value=\"Federal Bank\">Federal Bank<\/option><option value=\"ICICI Bank\">ICICI Bank<\/option><option value=\"IDBI Bank\">IDBI Bank<\/option><option value=\"Indian Bank\">Indian Bank<\/option><option value=\"Indian Overseas Bank\">Indian Overseas Bank<\/option><option value=\"IndusInd Bank\">IndusInd Bank<\/option><option value=\"ING Vysya Bank\">ING Vysya Bank<\/option><option value=\"Jammu and Kashmir Bank\">Jammu and Kashmir Bank<\/option><option value=\"Karnataka Bank Ltd\">Karnataka Bank Ltd<\/option><option value=\"Karur Vysya Bank\">Karur Vysya Bank<\/option><option value=\"Kotak Bank\">Kotak Bank<\/option><option value=\"Laxmi Vilas Bank\">Laxmi Vilas Bank<\/option><option value=\"Oriental Bank of Commerce\">Oriental Bank of Commerce<\/option><option value=\"Punjab National Bank - Corporate Banking\">Punjab National Bank \u2013 Corporate Banking<\/option><option value=\"Punjab National Bank - Retail Banking\">Punjab National Bank \u2013 Retail Banking<\/option><option value=\"Punjab &amp; Sind Bank\">Punjab &amp; Sind Bank<\/option><option value=\"Shamrao Vitthal Co-operative Bank\">Shamrao Vitthal Co-operative Bank<\/option><option value=\"South Indian Bank\">South Indian Bank<\/option><option value=\"State Bank of Bikaner &amp; Jaipur\">State Bank of Bikaner &amp; Jaipur<\/option><option value=\"State Bank of Hyderabad\">State Bank of Hyderabad<\/option><option value=\"State Bank of India\">State Bank of India<\/option><option value=\"State Bank of Mysore\">State Bank of Mysore<\/option><option value=\"State Bank of Patiala\">State Bank of Patiala<\/option><option value=\"State Bank of Travancore\">State Bank of Travancore<\/option><option value=\"Syndicate Bank\">Syndicate Bank<\/option><option value=\"Tamilnad Mercantile Bank Ltd.\">Tamilnad Mercantile Bank Ltd.<\/option><option value=\"UCO Bank\">UCO Bank<\/option><option value=\"Union Bank of India\">Union Bank of India<\/option><option value=\"United Bank of India\">United Bank of India<\/option><option value=\"Vijaya Bank\">Vijaya Bank<\/option><option value=\"Yes Bank Ltd\">Yes Bank Ltd<\/option><option value=\"Not Applicable\">Not Applicable<\/option><\/select><\/span><br>\n<\/label>\n<\/p>\n<p><label> <b> 14.Choose Your Gramin Bank(optional)<\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-247GraminBank\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-247GraminBank\"><option value=\"Select One\">Select One<\/option><option value=\"Andhra Pradesh Grameena Vikas Bank\">Andhra Pradesh Grameena Vikas Bank<\/option><option value=\"Andhra Pragathi Grameena Bank\">Andhra Pragathi Grameena Bank<\/option><option value=\"Arunachal Pradesh Rural Bank\">Arunachal Pradesh Rural Bank<\/option><option value=\"Aryavart Bank\">Aryavart Bank<\/option><option value=\"Assam Gramin Vikash Bank\">Assam Gramin Vikash Bank<\/option><option value=\"Bangiya Gramin Vikash Bank\">Bangiya Gramin Vikash Bank<\/option><option value=\"Baroda Gujarat Gramin Bank\">Baroda Gujarat Gramin Bank<\/option><option value=\"Baroda Rajasthan Kshetriya Gramin Bank\">Baroda Rajasthan Kshetriya Gramin Bank<\/option><option value=\"Baroda UP Bank\">Baroda UP Bank<\/option><option value=\"Chaitanya Godavari Grameena Bank\">Chaitanya Godavari Grameena Bank<\/option><option value=\"Chhattisgarh Rajya Gramin Bank\">Chhattisgarh Rajya Gramin Bank<\/option><option value=\"Dakshin Bihar Gramin Bank\">Dakshin Bihar Gramin Bank<\/option><option value=\"Ellaquai Dehati Bank\">Ellaquai Dehati Bank<\/option><option value=\"Himachal Pradesh Gramin Bank\">Himachal Pradesh Gramin Bank<\/option><option value=\"J&amp;K Grameen Bank\">J&amp;K Grameen Bank<\/option><option value=\"Jharkhand Rajya Gramin Bank\">Jharkhand Rajya Gramin Bank<\/option><option value=\"Karnataka Gramin Bank\">Karnataka Gramin Bank<\/option><option value=\"Karnataka Vikas Grameena Bank\">Karnataka Vikas Grameena Bank<\/option><option value=\"Kerala Gramin Bank\">Kerala Gramin Bank<\/option><option value=\"Madhya Pradesh Gramin Bank\">Madhya Pradesh Gramin Bank<\/option><option value=\"Madhyanchal Gramin Bank\">Madhyanchal Gramin Bank<\/option><option value=\"Maharashtra Gramin Bank\">Maharashtra Gramin Bank<\/option><option value=\"Manipur Rural Bank\">Manipur Rural Bank<\/option><option value=\"Meghalaya Rural Bank\">Meghalaya Rural Bank<\/option><option value=\"Mizoram Rural Bank\">Mizoram Rural Bank<\/option><option value=\"Nagaland Rural Bank\">Nagaland Rural Bank<\/option><option value=\"Odisha Gramya Bank\">Odisha Gramya Bank<\/option><option value=\"Paschim Banga Gramin Bank\">Paschim Banga Gramin Bank<\/option><option value=\"Prathama UP Gramin Bank\">Prathama UP Gramin Bank<\/option><option value=\"Puduvai Bharthiar Grama Bank\">Puduvai Bharthiar Grama Bank<\/option><option value=\"Punjab Gramin Bank\">Punjab Gramin Bank<\/option><option value=\"Rajasthan Marudhara Gramin Bank\">Rajasthan Marudhara Gramin Bank<\/option><option value=\"Saptagiri Grameena Bank\">Saptagiri Grameena Bank<\/option><option value=\"Sarva Haryana Gramin Bank\">Sarva Haryana Gramin Bank<\/option><option value=\"Saurashtra Gramin Bank\">Saurashtra Gramin Bank<\/option><option value=\"Tamil Nadu Grama Bank\">Tamil Nadu Grama Bank<\/option><option value=\"Telangana Grameena Bank\">Telangana Grameena Bank<\/option><option value=\"Tripura Gramin Bank\">Tripura Gramin Bank<\/option><option value=\"Utkal Grameen Bank\">Utkal Grameen Bank<\/option><option value=\"Uttar Banga Kshetriya Gramin Bank\">Uttar Banga Kshetriya Gramin Bank<\/option><option value=\"Uttar Bihar Gramin Bank\">Uttar Bihar Gramin Bank<\/option><option value=\"Uttarakhand Gramin Bank\">Uttarakhand Gramin Bank<\/option><option value=\"Vidharbha Konkan Gramin Bank\">Vidharbha Konkan Gramin Bank<\/option><option value=\"Not Applicable\">Not Applicable<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> <b>15.Bank Branch Address<\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-BankBrunchDetails\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-BankBrunchDetails\"><\/span><\/label><br>\n<label> <b>16.IFSC CODE <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-955IFSCCODE\"><input size=\"40\" maxlength=\"11\" minlength=\"9\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-955IFSCCODE\"><\/span><\/label>\n<\/p>\n\n<!----------------------------------  Strat Student's Passed Information---------->\n<p><label> <b>17.Merit Scholarship Scheme Application Form(optional) <\/b><br>\n<\/label>\n<\/p>\n<p><label> <b>18.Aggregate % Marks obtained in last class Passed (Please write in % only) <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Marksobtained\"><input size=\"40\" maxlength=\"6\" minlength=\"4\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Marksobtained\"><\/span><\/label>\n<\/p>\n<p><label> <b> 19.Name Of School \/ College \/ Institution \/ University (PASSED) <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><span class=\"wpcf7-form-control-wrap\" data-name=\"text-NameofSchool\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-NameofSchool\"><\/span><\/label>\n<\/p>\n<p><label> <b> 20.Address Of School \/ College \/ Institution (PASSED) <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"AddressOfSchool\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"AddressOfSchool\"><\/span><\/label>\n<\/p>\n<p><label> <b>21.Select your School States (PASSED) <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Passed_School_state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Passed_School_state\"><option value=\"\">\u2014Please choose an option\u2014<\/option><option value=\"Select One\">Select One<\/option><option value=\"Andaman and Nicobar Islands (union territory)\">Andaman and Nicobar Islands (union territory)<\/option><option value=\"Andhra Pradesh\">Andhra Pradesh<\/option><option value=\"Arunachal Pradesh\">Arunachal Pradesh<\/option><option value=\"Assam\">Assam<\/option><option value=\"Bihar\">Bihar<\/option><option value=\"Chandigarh (union territory)\">Chandigarh (union territory)<\/option><option value=\"Chhattisgarh\">Chhattisgarh<\/option><option value=\"Dadra and Nagar Haveli (union territory)\">Dadra and Nagar Haveli (union territory)<\/option><option value=\"Daman and Diu (union territory)\">Daman and Diu (union territory)<\/option><option value=\"Delhi (national capital territory)\">Delhi (national capital territory)<\/option><option value=\"Goa\">Goa<\/option><option value=\"Gujarat\">Gujarat<\/option><option value=\"Haryana\">Haryana<\/option><option value=\"Himachal Pradesh\">Himachal Pradesh<\/option><option value=\"Jammu and Kashmir (union territory)\">Jammu and Kashmir (union territory)<\/option><option value=\"Jharkhand\">Jharkhand<\/option><option value=\"Karnataka\">Karnataka<\/option><option value=\"Kerala\">Kerala<\/option><option value=\"Ladakh (union territory)\">Ladakh (union territory)<\/option><option value=\"Madhya Pradesh\">Madhya Pradesh<\/option><option value=\"Maharashtra\">Maharashtra<\/option><option value=\"Manipur\">Manipur<\/option><option value=\"Meghalaya\">Meghalaya<\/option><option value=\"Mizoram\">Mizoram<\/option><option value=\"Nagaland\">Nagaland<\/option><option value=\"Odisha\">Odisha<\/option><option value=\"Puducherry (union territory)\">Puducherry (union territory)<\/option><option value=\"Punjab\">Punjab<\/option><option value=\"Rajasthan\">Rajasthan<\/option><option value=\"Sikkim\">Sikkim<\/option><option value=\"Tamil Nadu\">Tamil Nadu<\/option><option value=\"Telangana\">Telangana<\/option><option value=\"Tripura\">Tripura<\/option><option value=\"Uttar Pradesh\">Uttar Pradesh<\/option><option value=\"Uttarakhand\">Uttarakhand<\/option><option value=\"West Bengal\">West Bengal<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> <b>22.Select your School City (PASSED)<\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-523SelectCities\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-523SelectCities\"><option value=\"Select One\">Select One<\/option><option value=\"Port Blair\">Port Blair<\/option><option value=\"Adoni\">Adoni<\/option><option value=\"Amaravati\">Amaravati<\/option><option value=\"Anantapur\">Anantapur<\/option><option value=\"Chandragiri\">Chandragiri<\/option><option value=\"Chittoor\">Chittoor<\/option><option value=\"Dowlaiswaram\">Dowlaiswaram<\/option><option value=\"Eluru\">Eluru<\/option><option value=\"Guntur\">Guntur<\/option><option value=\"Kadapa\">Kadapa<\/option><option value=\"Kakinada\">Kakinada<\/option><option value=\"Kurnool\">Kurnool<\/option><option value=\"Machilipatnam\">Machilipatnam<\/option><option value=\"Nagarjunako\u1e47\u1e0da\">Nagarjunako\u1e47\u1e0da<\/option><option value=\"Rajahmundry\">Rajahmundry<\/option><option value=\"Srikakulam\">Srikakulam<\/option><option value=\"Tirupati\">Tirupati<\/option><option value=\"Vijayawada\">Vijayawada<\/option><option value=\"Visakhapatnam\">Visakhapatnam<\/option><option value=\"Vizianagaram\">Vizianagaram<\/option><option value=\"Yemmiganur\">Yemmiganur<\/option><option value=\"Itanagar\">Itanagar<\/option><option value=\"Adoni\">Adoni<\/option><option value=\"Amaravati\">Amaravati<\/option><option value=\"Anantapur\">Anantapur<\/option><option value=\"Chandragiri\">Chandragiri<\/option><option value=\"Chittoor\">Chittoor<\/option><option value=\"Dowlaiswaram\">Dowlaiswaram<\/option><option value=\"Eluru\">Eluru<\/option><option value=\"Guntur\">Guntur<\/option><option value=\"Kadapa\">Kadapa<\/option><option value=\"Kakinada\">Kakinada<\/option><option value=\"Kurnool\">Kurnool<\/option><option value=\"Machilipatnam\">Machilipatnam<\/option><option value=\"Nagarjunako\u1e47\u1e0da\">Nagarjunako\u1e47\u1e0da<\/option><option value=\"Rajahmundry\">Rajahmundry<\/option><option value=\"Srikakulam\">Srikakulam<\/option><option value=\"Tirupati\">Tirupati<\/option><option value=\"Vijayawada\">Vijayawada<\/option><option value=\"Visakhapatnam\">Visakhapatnam<\/option><option value=\"Vizianagaram\">Vizianagaram<\/option><option value=\"Yemmiganur\">Yemmiganur<\/option><option value=\"Itanagar\">Itanagar<\/option><option value=\"Dhuburi\">Dhuburi<\/option><option value=\"Dibrugarh\">Dibrugarh<\/option><option value=\"Dispur\">Dispur<\/option><option value=\"Guwahati\">Guwahati<\/option><option value=\"Jorhat\">Jorhat<\/option><option value=\"Nagaon\">Nagaon<\/option><option value=\"Sibsagar\">Sibsagar<\/option><option value=\"Silchar\">Silchar<\/option><option value=\"Tezpur\">Tezpur<\/option><option value=\"Tinsukia\">Tinsukia<\/option><option value=\"Ara\">Ara<\/option><option value=\"Baruni\">Baruni<\/option><option value=\"Begusarai\">Begusarai<\/option><option value=\"Bettiah\">Bettiah<\/option><option value=\"Bhagalpur\">Bhagalpur<\/option><option value=\"Bihar Sharif\">Bihar Sharif<\/option><option value=\"Bodh Gaya\">Bodh Gaya<\/option><option value=\"Buxar\">Buxar<\/option><option value=\"Chapra\">Chapra<\/option><option value=\"Darbhanga\">Darbhanga<\/option><option value=\"Dehri\">Dehri<\/option><option value=\"Dinapur Nizamat\">Dinapur Nizamat<\/option><option value=\"Gaya\">Gaya<\/option><option value=\"Hajipur\">Hajipur<\/option><option value=\"Jamalpur\">Jamalpur<\/option><option value=\"Katihar\">Katihar<\/option><option value=\"Madhubani\">Madhubani<\/option><option value=\"Motihari\">Motihari<\/option><option value=\"Munger\">Munger<\/option><option value=\"Muzaffarpur\">Muzaffarpur<\/option><option value=\"Patna\">Patna<\/option><option value=\"Purnia\">Purnia<\/option><option value=\"Pusa\">Pusa<\/option><option value=\"Saharsa\">Saharsa<\/option><option value=\"Samastipur\">Samastipur<\/option><option value=\"Sasaram\">Sasaram<\/option><option value=\"Sitamarhi\">Sitamarhi<\/option><option value=\"Siwan\">Siwan<\/option><option value=\"\"><\/option><option value=\"Ambikapur\">Ambikapur<\/option><option value=\"Bhilai\">Bhilai<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Dhamtari\">Dhamtari<\/option><option value=\"Durg\">Durg<\/option><option value=\"Jagdalpur\">Jagdalpur<\/option><option value=\"Raipur\">Raipur<\/option><option value=\"Rajnandgaon\">Rajnandgaon<\/option><option value=\"Silvassa\">Silvassa<\/option><option value=\"Daman\">Daman<\/option><option value=\"Diu\">Diu<\/option><option value=\"Delhi\">Delhi<\/option><option value=\"New Delhi\">New Delhi<\/option><option value=\"Madgaon\">Madgaon<\/option><option value=\"Panaji\">Panaji<\/option><option value=\"Ahmadabad\">Ahmadabad<\/option><option value=\"Amreli\">Amreli<\/option><option value=\"Bharuch\">Bharuch<\/option><option value=\"Bhavnagar\">Bhavnagar<\/option><option value=\"Bhuj\">Bhuj<\/option><option value=\"Dwarka\">Dwarka<\/option><option value=\"Gandhinagar\">Gandhinagar<\/option><option value=\"Godhra\">Godhra<\/option><option value=\"Jamnagar\">Jamnagar<\/option><option value=\"Junagadh\">Junagadh<\/option><option value=\"Kandla\">Kandla<\/option><option value=\"Khambhat\">Khambhat<\/option><option value=\"Kheda\">Kheda<\/option><option value=\"Mahesana\">Mahesana<\/option><option value=\"Morvi\">Morvi<\/option><option value=\"Nadiad\">Nadiad<\/option><option value=\"Navsari\">Navsari<\/option><option value=\"Okha\">Okha<\/option><option value=\"Palanpur\">Palanpur<\/option><option value=\"Patan\">Patan<\/option><option value=\"Porbandar\">Porbandar<\/option><option value=\"Rajkot\">Rajkot<\/option><option value=\"Surat\">Surat<\/option><option value=\"Surendranagar\">Surendranagar<\/option><option value=\"Valsad\">Valsad<\/option><option value=\"Veraval\">Veraval<\/option><option value=\"Ambala\">Ambala<\/option><option value=\"Bhiwani\">Bhiwani<\/option><option value=\"Chandigarh\">Chandigarh<\/option><option value=\"Faridabad\">Faridabad<\/option><option value=\"Firozpur Jhirka\">Firozpur Jhirka<\/option><option value=\"Gurgaon\">Gurgaon<\/option><option value=\"Hansi\">Hansi<\/option><option value=\"Hisar\">Hisar<\/option><option value=\"Jind\">Jind<\/option><option value=\"Kaithal\">Kaithal<\/option><option value=\"Karnal\">Karnal<\/option><option value=\"Kurukshetra\">Kurukshetra<\/option><option value=\"Panipat\">Panipat<\/option><option value=\"Pehowa\">Pehowa<\/option><option value=\"Rewari\">Rewari<\/option><option value=\"Rohtak\">Rohtak<\/option><option value=\"Sirsa\">Sirsa<\/option><option value=\"Sonipat\">Sonipat<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Chamba\">Chamba<\/option><option value=\"Dalhousie\">Dalhousie<\/option><option value=\"Dharmshala\">Dharmshala<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Kangra\">Kangra<\/option><option value=\"Kullu\">Kullu<\/option><option value=\"Mandi\">Mandi<\/option><option value=\"Nahan\">Nahan<\/option><option value=\"Shimla\">Shimla<\/option><option value=\"Una\">Una<\/option><option value=\"Anantnag\">Anantnag<\/option><option value=\"Baramula\">Baramula<\/option><option value=\"Doda\">Doda<\/option><option value=\"Gulmarg\">Gulmarg<\/option><option value=\"Jammu\">Jammu<\/option><option value=\"Kathua\">Kathua<\/option><option value=\"Punch\">Punch<\/option><option value=\"Rajauri\">Rajauri<\/option><option value=\"Srinagar\">Srinagar<\/option><option value=\"Udhampur\">Udhampur<\/option><option value=\"Bokaro\">Bokaro<\/option><option value=\"Chaibasa\">Chaibasa<\/option><option value=\"Deoghar\">Deoghar<\/option><option value=\"Dhanbad\">Dhanbad<\/option><option value=\"Dumka\">Dumka<\/option><option value=\"Giridih\">Giridih<\/option><option value=\"Hazaribag\">Hazaribag<\/option><option value=\"Jamshedpur\">Jamshedpur<\/option><option value=\"Jharia\">Jharia<\/option><option value=\"Rajmahal\">Rajmahal<\/option><option value=\"Ranchi\">Ranchi<\/option><option value=\"Saraikela\">Saraikela<\/option><option value=\"Badami\">Badami<\/option><option value=\"Ballari\">Ballari<\/option><option value=\"Bangalore\">Bangalore<\/option><option value=\"Belgavi\">Belgavi<\/option><option value=\"Bhadravati\">Bhadravati<\/option><option value=\"Bidar\">Bidar<\/option><option value=\"Chikkamagaluru\">Chikkamagaluru<\/option><option value=\"Chitradurga\">Chitradurga<\/option><option value=\"Davangere\">Davangere<\/option><option value=\"Halebid\">Halebid<\/option><option value=\"Hassan\">Hassan<\/option><option value=\"Hubballi-Dharwad\">Hubballi-Dharwad<\/option><option value=\"Kalaburagi\">Kalaburagi<\/option><option value=\"Kolar\">Kolar<\/option><option value=\"Madikeri\">Madikeri<\/option><option value=\"Mandya\">Mandya<\/option><option value=\"Mangaluru\">Mangaluru<\/option><option value=\"Mysuru\">Mysuru<\/option><option value=\"Raichur\">Raichur<\/option><option value=\"Shivamogga\">Shivamogga<\/option><option value=\"Shravanabelagola\">Shravanabelagola<\/option><option value=\"Shrirangapattana\">Shrirangapattana<\/option><option value=\"Tumkuru\">Tumkuru<\/option><option value=\"Alappuzha\">Alappuzha<\/option><option value=\"Badagara\">Badagara<\/option><option value=\"Idukki\">Idukki<\/option><option value=\"Kannur\">Kannur<\/option><option value=\"Kochi\">Kochi<\/option><option value=\"Kollam\">Kollam<\/option><option value=\"Kottayam\">Kottayam<\/option><option value=\"Kozhikode\">Kozhikode<\/option><option value=\"Mattancheri\">Mattancheri<\/option><option value=\"Palakkad\">Palakkad<\/option><option value=\"Thalassery\">Thalassery<\/option><option value=\"Thiruvananthapuram\">Thiruvananthapuram<\/option><option value=\"Thrissur\">Thrissur<\/option><option value=\"Balaghat\">Balaghat<\/option><option value=\"Barwani\">Barwani<\/option><option value=\"Betul\">Betul<\/option><option value=\"Bharhut\">Bharhut<\/option><option value=\"Bhind\">Bhind<\/option><option value=\"Bhojpur\">Bhojpur<\/option><option value=\"Bhopal\">Bhopal<\/option><option value=\"Burhanpur\">Burhanpur<\/option><option value=\"Chhatarpur\">Chhatarpur<\/option><option value=\"Chhindwara\">Chhindwara<\/option><option value=\"Damoh\">Damoh<\/option><option value=\"Datia\">Datia<\/option><option value=\"Dewas\">Dewas<\/option><option value=\"Dhar\">Dhar<\/option><option value=\"Guna\">Guna<\/option><option value=\"Gwalior\">Gwalior<\/option><option value=\"Hoshangabad\">Hoshangabad<\/option><option value=\"Indore\">Indore<\/option><option value=\"Itarsi\">Itarsi<\/option><option value=\"Jabalpur\">Jabalpur<\/option><option value=\"Jhabua\">Jhabua<\/option><option value=\"Khajuraho\">Khajuraho<\/option><option value=\"Khandwa\">Khandwa<\/option><option value=\"Khargon\">Khargon<\/option><option value=\"Maheshwar\">Maheshwar<\/option><option value=\"Mandla\">Mandla<\/option><option value=\"Mandsaur\">Mandsaur<\/option><option value=\"Mhow\">Mhow<\/option><option value=\"Morena\">Morena<\/option><option value=\"Murwara\">Murwara<\/option><option value=\"Narsimhapur\">Narsimhapur<\/option><option value=\"Narsinghgarh\">Narsinghgarh<\/option><option value=\"Narwar\">Narwar<\/option><option value=\"Neemuch\">Neemuch<\/option><option value=\"Nowgong\">Nowgong<\/option><option value=\"Orchha\">Orchha<\/option><option value=\"Panna\">Panna<\/option><option value=\"Raisen\">Raisen<\/option><option value=\"Rajgarh\">Rajgarh<\/option><option value=\"Ratlam\">Ratlam<\/option><option value=\"Rewa\">Rewa<\/option><option value=\"Sagar\">Sagar<\/option><option value=\"Sarangpur\">Sarangpur<\/option><option value=\"Satna\">Satna<\/option><option value=\"Sehore\">Sehore<\/option><option value=\"Seoni\">Seoni<\/option><option value=\"Shahdol\">Shahdol<\/option><option value=\"Shajapur\">Shajapur<\/option><option value=\"Sheopur\">Sheopur<\/option><option value=\"Shivpuri\">Shivpuri<\/option><option value=\"Ujjain\">Ujjain<\/option><option value=\"Vidisha\">Vidisha<\/option><option value=\"Ahmadnagar\">Ahmadnagar<\/option><option value=\"Akola\">Akola<\/option><option value=\"Amravati\">Amravati<\/option><option value=\"Aurangabad\">Aurangabad<\/option><option value=\"Bhandara\">Bhandara<\/option><option value=\"Bhusawal\">Bhusawal<\/option><option value=\"Bid\">Bid<\/option><option value=\"Buldana\">Buldana<\/option><option value=\"Chandrapur\">Chandrapur<\/option><option value=\"Daulatabad\">Daulatabad<\/option><option value=\"Dhule\">Dhule<\/option><option value=\"Jalgaon\">Jalgaon<\/option><option value=\"Kalyan\">Kalyan<\/option><option value=\"Karli\">Karli<\/option><option value=\"Kolhapur\">Kolhapur<\/option><option value=\"Mahabaleshwar\">Mahabaleshwar<\/option><option value=\"Malegaon\">Malegaon<\/option><option value=\"Matheran\">Matheran<\/option><option value=\"Mumbai\">Mumbai<\/option><option value=\"Nagpur\">Nagpur<\/option><option value=\"Nanded\">Nanded<\/option><option value=\"Nashik\">Nashik<\/option><option value=\"Osmanabad\">Osmanabad<\/option><option value=\"Pandharpur\">Pandharpur<\/option><option value=\"Parbhani\">Parbhani<\/option><option value=\"Pune\">Pune<\/option><option value=\"Ratnagiri\">Ratnagiri<\/option><option value=\"Sangli\">Sangli<\/option><option value=\"Satara\">Satara<\/option><option value=\"Sevagram\">Sevagram<\/option><option value=\"Solapur\">Solapur<\/option><option value=\"Thane\">Thane<\/option><option value=\"Ulhasnagar\">Ulhasnagar<\/option><option value=\"Vasai-Virar\">Vasai-Virar<\/option><option value=\"Wardha\">Wardha<\/option><option value=\"Yavatmal\">Yavatmal<\/option><option value=\"Imphal\">Imphal<\/option><option value=\"Cherrapunji\">Cherrapunji<\/option><option value=\"Shillong\">Shillong<\/option><option value=\"Aizawl\">Aizawl<\/option><option value=\"Lunglei\">Lunglei<\/option><option value=\"Kohima\">Kohima<\/option><option value=\"Mon\">Mon<\/option><option value=\"Phek\">Phek<\/option><option value=\"Wokha\">Wokha<\/option><option value=\"Zunheboto\">Zunheboto<\/option><option value=\"Balangir\">Balangir<\/option><option value=\"Baleshwar\">Baleshwar<\/option><option value=\"Baripada\">Baripada<\/option><option value=\"Bhubaneshwar\">Bhubaneshwar<\/option><option value=\"Brahmapur\">Brahmapur<\/option><option value=\"Cuttack\">Cuttack<\/option><option value=\"Dhenkanal\">Dhenkanal<\/option><option value=\"Keonjhar\">Keonjhar<\/option><option value=\"Konark\">Konark<\/option><option value=\"Koraput\">Koraput<\/option><option value=\"Paradip\">Paradip<\/option><option value=\"Phulabani\">Phulabani<\/option><option value=\"Puri\">Puri<\/option><option value=\"Sambalpur\">Sambalpur<\/option><option value=\"Udayagiri\">Udayagiri<\/option><option value=\"Karaikal\">Karaikal<\/option><option value=\"Mahe\">Mahe<\/option><option value=\"Puducherry\">Puducherry<\/option><option value=\"Yanam\">Yanam<\/option><option value=\"Amritsar\">Amritsar<\/option><option value=\"Batala\">Batala<\/option><option value=\"Chandigarh\">Chandigarh<\/option><option value=\"Faridkot\">Faridkot<\/option><option value=\"Firozpur\">Firozpur<\/option><option value=\"Gurdaspur\">Gurdaspur<\/option><option value=\"Hoshiarpur\">Hoshiarpur<\/option><option value=\"Jalandhar\">Jalandhar<\/option><option value=\"Kapurthala\">Kapurthala<\/option><option value=\"Ludhiana\">Ludhiana<\/option><option value=\"Nabha\">Nabha<\/option><option value=\"Patiala\">Patiala<\/option><option value=\"Rupnagar\">Rupnagar<\/option><option value=\"Sangrur\">Sangrur<\/option><option value=\"Abu\">Abu<\/option><option value=\"Ajmer\">Ajmer<\/option><option value=\"Alwar\">Alwar<\/option><option value=\"Amer\">Amer<\/option><option value=\"Barmer\">Barmer<\/option><option value=\"Beawar\">Beawar<\/option><option value=\"Bharatpur\">Bharatpur<\/option><option value=\"Bhilwara\">Bhilwara<\/option><option value=\"Bikaner\">Bikaner<\/option><option value=\"Bundi\">Bundi<\/option><option value=\"Chittaurgarh\">Chittaurgarh<\/option><option value=\"Churu\">Churu<\/option><option value=\"Dhaulpur\">Dhaulpur<\/option><option value=\"Dungarpur\">Dungarpur<\/option><option value=\"Ganganagar\">Ganganagar<\/option><option value=\"Hanumangarh\">Hanumangarh<\/option><option value=\"Jaipur\">Jaipur<\/option><option value=\"Jaisalmer\">Jaisalmer<\/option><option value=\"Jalor\">Jalor<\/option><option value=\"Jhalawar\">Jhalawar<\/option><option value=\"Jhunjhunu\">Jhunjhunu<\/option><option value=\"Jodhpur\">Jodhpur<\/option><option value=\"Kishangarh\">Kishangarh<\/option><option value=\"Kota\">Kota<\/option><option value=\"Merta\">Merta<\/option><option value=\"Nagaur\">Nagaur<\/option><option value=\"Nathdwara\">Nathdwara<\/option><option value=\"Pali\">Pali<\/option><option value=\"Phalodi\">Phalodi<\/option><option value=\"Pushkar\">Pushkar<\/option><option value=\"Sawai Madhopur\">Sawai Madhopur<\/option><option value=\"Shahpura\">Shahpura<\/option><option value=\"Sikar\">Sikar<\/option><option value=\"Sirohi\">Sirohi<\/option><option value=\"Tonk\">Tonk<\/option><option value=\"Udaipur\">Udaipur<\/option><option value=\"Gangtok\">Gangtok<\/option><option value=\"Gyalsing\">Gyalsing<\/option><option value=\"Lachung\">Lachung<\/option><option value=\"Mangan\">Mangan<\/option><option value=\"Arcot\">Arcot<\/option><option value=\"Chengalpattu\">Chengalpattu<\/option><option value=\"Chennai\">Chennai<\/option><option value=\"Chidambaram\">Chidambaram<\/option><option value=\"Coimbatore\">Coimbatore<\/option><option value=\"Cuddalore\">Cuddalore<\/option><option value=\"Dharmapuri\">Dharmapuri<\/option><option value=\"Dindigul\">Dindigul<\/option><option value=\"Erode\">Erode<\/option><option value=\"Kanchipuram\">Kanchipuram<\/option><option value=\"Kanniyakumari\">Kanniyakumari<\/option><option value=\"Kodaikanal\">Kodaikanal<\/option><option value=\"Kumbakonam\">Kumbakonam<\/option><option value=\"Madurai\">Madurai<\/option><option value=\"Mamallapuram\">Mamallapuram<\/option><option value=\"Nagappattinam\">Nagappattinam<\/option><option value=\"Nagercoil\">Nagercoil<\/option><option value=\"Palayankottai\">Palayankottai<\/option><option value=\"Pudukkottai\">Pudukkottai<\/option><option value=\"Rajapalaiyam\">Rajapalaiyam<\/option><option value=\"Ramanathapuram\">Ramanathapuram<\/option><option value=\"Salem\">Salem<\/option><option value=\"Thanjavur\">Thanjavur<\/option><option value=\"Tiruchchirappalli\">Tiruchchirappalli<\/option><option value=\"Tirunelveli\">Tirunelveli<\/option><option value=\"Tiruppur\">Tiruppur<\/option><option value=\"Tuticorin\">Tuticorin<\/option><option value=\"Udhagamandalam\">Udhagamandalam<\/option><option value=\"Vellore\">Vellore<\/option><option value=\"Hyderabad\">Hyderabad<\/option><option value=\"Karimnagar\">Karimnagar<\/option><option value=\"Khammam\">Khammam<\/option><option value=\"Mahbubnagar\">Mahbubnagar<\/option><option value=\"Nizamabad\">Nizamabad<\/option><option value=\"Sangareddi\">Sangareddi<\/option><option value=\"Warangal\">Warangal<\/option><option value=\"Agartala\">Agartala<\/option><option value=\"Agra\">Agra<\/option><option value=\"Aligarh\">Aligarh<\/option><option value=\"Amroha\">Amroha<\/option><option value=\"Ayodhya\">Ayodhya<\/option><option value=\"Azamgarh\">Azamgarh<\/option><option value=\"Bahraich\">Bahraich<\/option><option value=\"Ballia\">Ballia<\/option><option value=\"Banda\">Banda<\/option><option value=\"Bara Banki\">Bara Banki<\/option><option value=\"Bareilly\">Bareilly<\/option><option value=\"Basti\">Basti<\/option><option value=\"Bijnor\">Bijnor<\/option><option value=\"Bithur\">Bithur<\/option><option value=\"Budaun\">Budaun<\/option><option value=\"Bulandshahr\">Bulandshahr<\/option><option value=\"Deoria\">Deoria<\/option><option value=\"Etah\">Etah<\/option><option value=\"Etawah\">Etawah<\/option><option value=\"Faizabad\">Faizabad<\/option><option value=\"Farrukhabad-cum-Fatehgarh\">Farrukhabad-cum-Fatehgarh<\/option><option value=\"Fatehpur\">Fatehpur<\/option><option value=\"Fatehpur Sikri\">Fatehpur Sikri<\/option><option value=\"Ghaziabad\">Ghaziabad<\/option><option value=\"Ghazipur\">Ghazipur<\/option><option value=\"Gonda\">Gonda<\/option><option value=\"Gorakhpur\">Gorakhpur<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Hardoi\">Hardoi<\/option><option value=\"Hathras\">Hathras<\/option><option value=\"Jalaun\">Jalaun<\/option><option value=\"Jaunpur\">Jaunpur<\/option><option value=\"Jhansi\">Jhansi<\/option><option value=\"Kannauj\">Kannauj<\/option><option value=\"Kanpur\">Kanpur<\/option><option value=\"Lakhimpur\">Lakhimpur<\/option><option value=\"Lalitpur\">Lalitpur<\/option><option value=\"Lucknow\">Lucknow<\/option><option value=\"Mainpuri\">Mainpuri<\/option><option value=\"Mathura\">Mathura<\/option><option value=\"Meerut\">Meerut<\/option><option value=\"Mirzapur-Vindhyachal\">Mirzapur-Vindhyachal<\/option><option value=\"Moradabad\">Moradabad<\/option><option value=\"Muzaffarnagar\">Muzaffarnagar<\/option><option value=\"Partapgarh\">Partapgarh<\/option><option value=\"Pilibhit\">Pilibhit<\/option><option value=\"Prayagraj\">Prayagraj<\/option><option value=\"Rae Bareli\">Rae Bareli<\/option><option value=\"Rampur\">Rampur<\/option><option value=\"Saharanpur\">Saharanpur<\/option><option value=\"Sambhal\">Sambhal<\/option><option value=\"Shahjahanpur\">Shahjahanpur<\/option><option value=\"Sitapur\">Sitapur<\/option><option value=\"Sultanpur\">Sultanpur<\/option><option value=\"Tehri\">Tehri<\/option><option value=\"Varanasi\">Varanasi<\/option><option value=\"Almora\">Almora<\/option><option value=\"Dehra Dun\">Dehra Dun<\/option><option value=\"Haridwar\">Haridwar<\/option><option value=\"Mussoorie\">Mussoorie<\/option><option value=\"Nainital\">Nainital<\/option><option value=\"Pithoragarh\">Pithoragarh<\/option><option value=\"Alipore\">Alipore<\/option><option value=\"Alipur Duar\">Alipur Duar<\/option><option value=\"Asansol\">Asansol<\/option><option value=\"Baharampur\">Baharampur<\/option><option value=\"Bally\">Bally<\/option><option value=\"Balurghat\">Balurghat<\/option><option value=\"Bankura\">Bankura<\/option><option value=\"Baranagar\">Baranagar<\/option><option value=\"Barasat\">Barasat<\/option><option value=\"Barrackpore\">Barrackpore<\/option><option value=\"Basirhat\">Basirhat<\/option><option value=\"Bhatpara\">Bhatpara<\/option><option value=\"Bishnupur\">Bishnupur<\/option><option value=\"Budge Budge\">Budge Budge<\/option><option value=\"Burdwan\">Burdwan<\/option><option value=\"Chandernagore\">Chandernagore<\/option><option value=\"Darjiling\">Darjiling<\/option><option value=\"Diamond Harbour\">Diamond Harbour<\/option><option value=\"Dum Dum\">Dum Dum<\/option><option value=\"Durgapur\">Durgapur<\/option><option value=\"Halisahar\">Halisahar<\/option><option value=\"Haora\">Haora<\/option><option value=\"Hugli\">Hugli<\/option><option value=\"Ingraj Bazar\">Ingraj Bazar<\/option><option value=\"Jalpaiguri\">Jalpaiguri<\/option><option value=\"Kalimpong\">Kalimpong<\/option><option value=\"Kamarhati\">Kamarhati<\/option><option value=\"Kanchrapara\">Kanchrapara<\/option><option value=\"Kharagpur\">Kharagpur<\/option><option value=\"Koch Bihar\">Koch Bihar<\/option><option value=\"Kolkata\">Kolkata<\/option><option value=\"Krishnanagar\">Krishnanagar<\/option><option value=\"Malda\">Malda<\/option><option value=\"Midnapore\">Midnapore<\/option><option value=\"Murshidabad\">Murshidabad<\/option><option value=\"Navadwip\">Navadwip<\/option><option value=\"Palashi\">Palashi<\/option><option value=\"Panihati\">Panihati<\/option><option value=\"Purulia\">Purulia<\/option><option value=\"Raiganj\">Raiganj<\/option><option value=\"Santipur\">Santipur<\/option><option value=\"Shantiniketan\">Shantiniketan<\/option><option value=\"Shrirampur\">Shrirampur<\/option><option value=\"Siliguri\">Siliguri<\/option><option value=\"Siuri\">Siuri<\/option><option value=\"Tamluk\">Tamluk<\/option><option value=\"Titagarh\">Titagarh<\/option><option value=\"Others Cities\">Others Cities<\/option><\/select><\/span><\/label>\n<\/p>\n<p>[group PassedCities]<br>\n<label><b> 22A.Mention your School City Name: (If Your City\/Town not in above list)<\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"If_required_Passed_Cities\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"If_required_Passed_Cities\"><\/span><br>\n<\/label><br>\n[\/group]\n<\/p>\n<p><label> <b>23.Pin Code of School \/ College \/ Institution (PASSED)\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split> <\/b><\/label>\n<\/p>\n<p style=\"Font-size:15px\" ;>(Please enter correct pincode as per school Address)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"PinCodeofSchool\"><input size=\"40\" maxlength=\"6\" minlength=\"5\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PinCodeofSchool\"><\/span>\n<\/p>\n\n<!---------------------------------- END Student's Passed Information---------->\n\n<!--------------------------------------START STUDENT's Passed Information------------------->\n<p><label> <b>24.Subjects<\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><\/label><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-PassedSubject\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Maths \/ Mathematics\"><span class=\"wpcf7-list-item-label\">Maths \/ Mathematics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Algebra\"><span class=\"wpcf7-list-item-label\">Algebra<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Geometry\"><span class=\"wpcf7-list-item-label\">Geometry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Biology\"><span class=\"wpcf7-list-item-label\">Biology<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Physics\"><span class=\"wpcf7-list-item-label\">Physics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Chemistry\"><span class=\"wpcf7-list-item-label\">Chemistry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Geography\"><span class=\"wpcf7-list-item-label\">Geography<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"History\"><span class=\"wpcf7-list-item-label\">History<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Citizenship\"><span class=\"wpcf7-list-item-label\">Citizenship<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Physical Education (P.E)\"><span class=\"wpcf7-list-item-label\">Physical Education (P.E)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Business Studies\"><span class=\"wpcf7-list-item-label\">Business Studies<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Home Economics\"><span class=\"wpcf7-list-item-label\">Home Economics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Trigonometry\"><span class=\"wpcf7-list-item-label\">Trigonometry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Statistics\"><span class=\"wpcf7-list-item-label\">Statistics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"English\"><span class=\"wpcf7-list-item-label\">English<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Hindi\"><span class=\"wpcf7-list-item-label\">Hindi<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Bengali\"><span class=\"wpcf7-list-item-label\">Bengali<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Computer Application\"><span class=\"wpcf7-list-item-label\">Computer Application<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Statistical\"><span class=\"wpcf7-list-item-label\">Statistical<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Economics\"><span class=\"wpcf7-list-item-label\">Economics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Computer Science\"><span class=\"wpcf7-list-item-label\">Computer Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Science\"><span class=\"wpcf7-list-item-label\">Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Sanskrit\"><span class=\"wpcf7-list-item-label\">Sanskrit<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Accounts\"><span class=\"wpcf7-list-item-label\">Accounts<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Social Science\"><span class=\"wpcf7-list-item-label\">Social Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Physical Science\"><span class=\"wpcf7-list-item-label\">Physical Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Life Science\"><span class=\"wpcf7-list-item-label\">Life Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Urdu\"><span class=\"wpcf7-list-item-label\">Urdu<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-PassedSubject[]\" value=\"Other Subjects\"><span class=\"wpcf7-list-item-label\">Other Subjects<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p>[group PassedSubject]<br>\n<label> <b>24A.If Others Subject, Please Specify (Passed) <\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SubjectSpecifyPassed\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"SubjectSpecifyPassed\"><\/span><\/label>[\/group]\n<\/p>\n<p><label> <b>25. Name Of School \/ College \/ Institution (PRESENTLY PURSUING)\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PursuSchoolName\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PursuSchoolName\"><\/span><\/label>\n<\/p>\n<p><label> <b>26.Address Of School \/ College \/ Institution (PRESENTLY PURSUING)\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PursuSchoolAddress\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PursuSchoolAddress\"><\/span><\/label>\n<\/p>\n<p><label> <b>27. Select your School States (PRESENTLY PURSUING)\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PursuSchoolStates\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"PursuSchoolStates\"><option value=\"\">\u2014Please choose an option\u2014<\/option><option value=\"Select One\">Select One<\/option><option value=\"Select One\">Select One<\/option><option value=\"Andaman and Nicobar Islands (union territory)\">Andaman and Nicobar Islands (union territory)<\/option><option value=\"Andhra Pradesh\">Andhra Pradesh<\/option><option value=\"Arunachal Pradesh\">Arunachal Pradesh<\/option><option value=\"Assam\">Assam<\/option><option value=\"Bihar\">Bihar<\/option><option value=\"Chandigarh (union territory)\">Chandigarh (union territory)<\/option><option value=\"Chhattisgarh\">Chhattisgarh<\/option><option value=\"Dadra and Nagar Haveli (union territory)\">Dadra and Nagar Haveli (union territory)<\/option><option value=\"Daman and Diu (union territory)\">Daman and Diu (union territory)<\/option><option value=\"Delhi (national capital territory)\">Delhi (national capital territory)<\/option><option value=\"Goa\">Goa<\/option><option value=\"Gujarat\">Gujarat<\/option><option value=\"Haryana\">Haryana<\/option><option value=\"Himachal Pradesh\">Himachal Pradesh<\/option><option value=\"Jammu and Kashmir (union territory)\">Jammu and Kashmir (union territory)<\/option><option value=\"Jharkhand\">Jharkhand<\/option><option value=\"Karnataka\">Karnataka<\/option><option value=\"Kerala\">Kerala<\/option><option value=\"Ladakh (union territory)\">Ladakh (union territory)<\/option><option value=\"Madhya Pradesh\">Madhya Pradesh<\/option><option value=\"Maharashtra\">Maharashtra<\/option><option value=\"Manipur\">Manipur<\/option><option value=\"Meghalaya\">Meghalaya<\/option><option value=\"Mizoram\">Mizoram<\/option><option value=\"Nagaland\">Nagaland<\/option><option value=\"Odisha\">Odisha<\/option><option value=\"Puducherry (union territory)\">Puducherry (union territory)<\/option><option value=\"Punjab\">Punjab<\/option><option value=\"Rajasthan\">Rajasthan<\/option><option value=\"Sikkim\">Sikkim<\/option><option value=\"Tamil Nadu\">Tamil Nadu<\/option><option value=\"Telangana\">Telangana<\/option><option value=\"Tripura\">Tripura<\/option><option value=\"Uttar Pradesh\">Uttar Pradesh<\/option><option value=\"Uttarakhand\">Uttarakhand<\/option><option value=\"West Bengal\">West Bengal<\/option><\/select><\/span><\/b><\/label>\n<\/p>\n<p><label> <b>28.Select your School Cities (PRESENTLY PURSUING)\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Pursu_School_Cities\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Pursu_School_Cities\"><option value=\"\">\u2014Please choose an option\u2014<\/option><option value=\"Select One\">Select One<\/option><option value=\"Port Blair\">Port Blair<\/option><option value=\"Adoni\">Adoni<\/option><option value=\"Amaravati\">Amaravati<\/option><option value=\"Anantapur\">Anantapur<\/option><option value=\"Chandragiri\">Chandragiri<\/option><option value=\"Chittoor\">Chittoor<\/option><option value=\"Dowlaiswaram\">Dowlaiswaram<\/option><option value=\"Eluru\">Eluru<\/option><option value=\"Guntur\">Guntur<\/option><option value=\"Kadapa\">Kadapa<\/option><option value=\"Kakinada\">Kakinada<\/option><option value=\"Kurnool\">Kurnool<\/option><option value=\"Machilipatnam\">Machilipatnam<\/option><option value=\"Nagarjunako\u1e47\u1e0da\">Nagarjunako\u1e47\u1e0da<\/option><option value=\"Rajahmundry\">Rajahmundry<\/option><option value=\"Srikakulam\">Srikakulam<\/option><option value=\"Tirupati\">Tirupati<\/option><option value=\"Vijayawada\">Vijayawada<\/option><option value=\"Visakhapatnam\">Visakhapatnam<\/option><option value=\"Vizianagaram\">Vizianagaram<\/option><option value=\"Yemmiganur\">Yemmiganur<\/option><option value=\"Itanagar\">Itanagar<\/option><option value=\"Adoni\">Adoni<\/option><option value=\"Amaravati\">Amaravati<\/option><option value=\"Anantapur\">Anantapur<\/option><option value=\"Chandragiri\">Chandragiri<\/option><option value=\"Chittoor\">Chittoor<\/option><option value=\"Dowlaiswaram\">Dowlaiswaram<\/option><option value=\"Eluru\">Eluru<\/option><option value=\"Guntur\">Guntur<\/option><option value=\"Kadapa\">Kadapa<\/option><option value=\"Kakinada\">Kakinada<\/option><option value=\"Kurnool\">Kurnool<\/option><option value=\"Machilipatnam\">Machilipatnam<\/option><option value=\"Nagarjunako\u1e47\u1e0da\">Nagarjunako\u1e47\u1e0da<\/option><option value=\"Rajahmundry\">Rajahmundry<\/option><option value=\"Srikakulam\">Srikakulam<\/option><option value=\"Tirupati\">Tirupati<\/option><option value=\"Vijayawada\">Vijayawada<\/option><option value=\"Visakhapatnam\">Visakhapatnam<\/option><option value=\"Vizianagaram\">Vizianagaram<\/option><option value=\"Yemmiganur\">Yemmiganur<\/option><option value=\"Itanagar\">Itanagar<\/option><option value=\"Dhuburi\">Dhuburi<\/option><option value=\"Dibrugarh\">Dibrugarh<\/option><option value=\"Dispur\">Dispur<\/option><option value=\"Guwahati\">Guwahati<\/option><option value=\"Jorhat\">Jorhat<\/option><option value=\"Nagaon\">Nagaon<\/option><option value=\"Sibsagar\">Sibsagar<\/option><option value=\"Silchar\">Silchar<\/option><option value=\"Tezpur\">Tezpur<\/option><option value=\"Tinsukia\">Tinsukia<\/option><option value=\"Ara\">Ara<\/option><option value=\"Baruni\">Baruni<\/option><option value=\"Begusarai\">Begusarai<\/option><option value=\"Bettiah\">Bettiah<\/option><option value=\"Bhagalpur\">Bhagalpur<\/option><option value=\"Bihar Sharif\">Bihar Sharif<\/option><option value=\"Bodh Gaya\">Bodh Gaya<\/option><option value=\"Buxar\">Buxar<\/option><option value=\"Chapra\">Chapra<\/option><option value=\"Darbhanga\">Darbhanga<\/option><option value=\"Dehri\">Dehri<\/option><option value=\"Dinapur Nizamat\">Dinapur Nizamat<\/option><option value=\"Gaya\">Gaya<\/option><option value=\"Hajipur\">Hajipur<\/option><option value=\"Jamalpur\">Jamalpur<\/option><option value=\"Katihar\">Katihar<\/option><option value=\"Madhubani\">Madhubani<\/option><option value=\"Motihari\">Motihari<\/option><option value=\"Munger\">Munger<\/option><option value=\"Muzaffarpur\">Muzaffarpur<\/option><option value=\"Patna\">Patna<\/option><option value=\"Purnia\">Purnia<\/option><option value=\"Pusa\">Pusa<\/option><option value=\"Saharsa\">Saharsa<\/option><option value=\"Samastipur\">Samastipur<\/option><option value=\"Sasaram\">Sasaram<\/option><option value=\"Sitamarhi\">Sitamarhi<\/option><option value=\"Siwan\">Siwan<\/option><option value=\"\"><\/option><option value=\"Ambikapur\">Ambikapur<\/option><option value=\"Bhilai\">Bhilai<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Dhamtari\">Dhamtari<\/option><option value=\"Durg\">Durg<\/option><option value=\"Jagdalpur\">Jagdalpur<\/option><option value=\"Raipur\">Raipur<\/option><option value=\"Rajnandgaon\">Rajnandgaon<\/option><option value=\"Silvassa\">Silvassa<\/option><option value=\"Daman\">Daman<\/option><option value=\"Diu\">Diu<\/option><option value=\"Delhi\">Delhi<\/option><option value=\"New Delhi\">New Delhi<\/option><option value=\"Madgaon\">Madgaon<\/option><option value=\"Panaji\">Panaji<\/option><option value=\"Ahmadabad\">Ahmadabad<\/option><option value=\"Amreli\">Amreli<\/option><option value=\"Bharuch\">Bharuch<\/option><option value=\"Bhavnagar\">Bhavnagar<\/option><option value=\"Bhuj\">Bhuj<\/option><option value=\"Dwarka\">Dwarka<\/option><option value=\"Gandhinagar\">Gandhinagar<\/option><option value=\"Godhra\">Godhra<\/option><option value=\"Jamnagar\">Jamnagar<\/option><option value=\"Junagadh\">Junagadh<\/option><option value=\"Kandla\">Kandla<\/option><option value=\"Khambhat\">Khambhat<\/option><option value=\"Kheda\">Kheda<\/option><option value=\"Mahesana\">Mahesana<\/option><option value=\"Morvi\">Morvi<\/option><option value=\"Nadiad\">Nadiad<\/option><option value=\"Navsari\">Navsari<\/option><option value=\"Okha\">Okha<\/option><option value=\"Palanpur\">Palanpur<\/option><option value=\"Patan\">Patan<\/option><option value=\"Porbandar\">Porbandar<\/option><option value=\"Rajkot\">Rajkot<\/option><option value=\"Surat\">Surat<\/option><option value=\"Surendranagar\">Surendranagar<\/option><option value=\"Valsad\">Valsad<\/option><option value=\"Veraval\">Veraval<\/option><option value=\"Ambala\">Ambala<\/option><option value=\"Bhiwani\">Bhiwani<\/option><option value=\"Chandigarh\">Chandigarh<\/option><option value=\"Faridabad\">Faridabad<\/option><option value=\"Firozpur Jhirka\">Firozpur Jhirka<\/option><option value=\"Gurgaon\">Gurgaon<\/option><option value=\"Hansi\">Hansi<\/option><option value=\"Hisar\">Hisar<\/option><option value=\"Jind\">Jind<\/option><option value=\"Kaithal\">Kaithal<\/option><option value=\"Karnal\">Karnal<\/option><option value=\"Kurukshetra\">Kurukshetra<\/option><option value=\"Panipat\">Panipat<\/option><option value=\"Pehowa\">Pehowa<\/option><option value=\"Rewari\">Rewari<\/option><option value=\"Rohtak\">Rohtak<\/option><option value=\"Sirsa\">Sirsa<\/option><option value=\"Sonipat\">Sonipat<\/option><option value=\"Bilaspur\">Bilaspur<\/option><option value=\"Chamba\">Chamba<\/option><option value=\"Dalhousie\">Dalhousie<\/option><option value=\"Dharmshala\">Dharmshala<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Kangra\">Kangra<\/option><option value=\"Kullu\">Kullu<\/option><option value=\"Mandi\">Mandi<\/option><option value=\"Nahan\">Nahan<\/option><option value=\"Shimla\">Shimla<\/option><option value=\"Una\">Una<\/option><option value=\"Anantnag\">Anantnag<\/option><option value=\"Baramula\">Baramula<\/option><option value=\"Doda\">Doda<\/option><option value=\"Gulmarg\">Gulmarg<\/option><option value=\"Jammu\">Jammu<\/option><option value=\"Kathua\">Kathua<\/option><option value=\"Punch\">Punch<\/option><option value=\"Rajauri\">Rajauri<\/option><option value=\"Srinagar\">Srinagar<\/option><option value=\"Udhampur\">Udhampur<\/option><option value=\"Bokaro\">Bokaro<\/option><option value=\"Chaibasa\">Chaibasa<\/option><option value=\"Deoghar\">Deoghar<\/option><option value=\"Dhanbad\">Dhanbad<\/option><option value=\"Dumka\">Dumka<\/option><option value=\"Giridih\">Giridih<\/option><option value=\"Hazaribag\">Hazaribag<\/option><option value=\"Jamshedpur\">Jamshedpur<\/option><option value=\"Jharia\">Jharia<\/option><option value=\"Rajmahal\">Rajmahal<\/option><option value=\"Ranchi\">Ranchi<\/option><option value=\"Saraikela\">Saraikela<\/option><option value=\"Badami\">Badami<\/option><option value=\"Ballari\">Ballari<\/option><option value=\"Bangalore\">Bangalore<\/option><option value=\"Belgavi\">Belgavi<\/option><option value=\"Bhadravati\">Bhadravati<\/option><option value=\"Bidar\">Bidar<\/option><option value=\"Chikkamagaluru\">Chikkamagaluru<\/option><option value=\"Chitradurga\">Chitradurga<\/option><option value=\"Davangere\">Davangere<\/option><option value=\"Halebid\">Halebid<\/option><option value=\"Hassan\">Hassan<\/option><option value=\"Hubballi-Dharwad\">Hubballi-Dharwad<\/option><option value=\"Kalaburagi\">Kalaburagi<\/option><option value=\"Kolar\">Kolar<\/option><option value=\"Madikeri\">Madikeri<\/option><option value=\"Mandya\">Mandya<\/option><option value=\"Mangaluru\">Mangaluru<\/option><option value=\"Mysuru\">Mysuru<\/option><option value=\"Raichur\">Raichur<\/option><option value=\"Shivamogga\">Shivamogga<\/option><option value=\"Shravanabelagola\">Shravanabelagola<\/option><option value=\"Shrirangapattana\">Shrirangapattana<\/option><option value=\"Tumkuru\">Tumkuru<\/option><option value=\"Alappuzha\">Alappuzha<\/option><option value=\"Badagara\">Badagara<\/option><option value=\"Idukki\">Idukki<\/option><option value=\"Kannur\">Kannur<\/option><option value=\"Kochi\">Kochi<\/option><option value=\"Kollam\">Kollam<\/option><option value=\"Kottayam\">Kottayam<\/option><option value=\"Kozhikode\">Kozhikode<\/option><option value=\"Mattancheri\">Mattancheri<\/option><option value=\"Palakkad\">Palakkad<\/option><option value=\"Thalassery\">Thalassery<\/option><option value=\"Thiruvananthapuram\">Thiruvananthapuram<\/option><option value=\"Thrissur\">Thrissur<\/option><option value=\"Balaghat\">Balaghat<\/option><option value=\"Barwani\">Barwani<\/option><option value=\"Betul\">Betul<\/option><option value=\"Bharhut\">Bharhut<\/option><option value=\"Bhind\">Bhind<\/option><option value=\"Bhojpur\">Bhojpur<\/option><option value=\"Bhopal\">Bhopal<\/option><option value=\"Burhanpur\">Burhanpur<\/option><option value=\"Chhatarpur\">Chhatarpur<\/option><option value=\"Chhindwara\">Chhindwara<\/option><option value=\"Damoh\">Damoh<\/option><option value=\"Datia\">Datia<\/option><option value=\"Dewas\">Dewas<\/option><option value=\"Dhar\">Dhar<\/option><option value=\"Guna\">Guna<\/option><option value=\"Gwalior\">Gwalior<\/option><option value=\"Hoshangabad\">Hoshangabad<\/option><option value=\"Indore\">Indore<\/option><option value=\"Itarsi\">Itarsi<\/option><option value=\"Jabalpur\">Jabalpur<\/option><option value=\"Jhabua\">Jhabua<\/option><option value=\"Khajuraho\">Khajuraho<\/option><option value=\"Khandwa\">Khandwa<\/option><option value=\"Khargon\">Khargon<\/option><option value=\"Maheshwar\">Maheshwar<\/option><option value=\"Mandla\">Mandla<\/option><option value=\"Mandsaur\">Mandsaur<\/option><option value=\"Mhow\">Mhow<\/option><option value=\"Morena\">Morena<\/option><option value=\"Murwara\">Murwara<\/option><option value=\"Narsimhapur\">Narsimhapur<\/option><option value=\"Narsinghgarh\">Narsinghgarh<\/option><option value=\"Narwar\">Narwar<\/option><option value=\"Neemuch\">Neemuch<\/option><option value=\"Nowgong\">Nowgong<\/option><option value=\"Orchha\">Orchha<\/option><option value=\"Panna\">Panna<\/option><option value=\"Raisen\">Raisen<\/option><option value=\"Rajgarh\">Rajgarh<\/option><option value=\"Ratlam\">Ratlam<\/option><option value=\"Rewa\">Rewa<\/option><option value=\"Sagar\">Sagar<\/option><option value=\"Sarangpur\">Sarangpur<\/option><option value=\"Satna\">Satna<\/option><option value=\"Sehore\">Sehore<\/option><option value=\"Seoni\">Seoni<\/option><option value=\"Shahdol\">Shahdol<\/option><option value=\"Shajapur\">Shajapur<\/option><option value=\"Sheopur\">Sheopur<\/option><option value=\"Shivpuri\">Shivpuri<\/option><option value=\"Ujjain\">Ujjain<\/option><option value=\"Vidisha\">Vidisha<\/option><option value=\"Ahmadnagar\">Ahmadnagar<\/option><option value=\"Akola\">Akola<\/option><option value=\"Amravati\">Amravati<\/option><option value=\"Aurangabad\">Aurangabad<\/option><option value=\"Bhandara\">Bhandara<\/option><option value=\"Bhusawal\">Bhusawal<\/option><option value=\"Bid\">Bid<\/option><option value=\"Buldana\">Buldana<\/option><option value=\"Chandrapur\">Chandrapur<\/option><option value=\"Daulatabad\">Daulatabad<\/option><option value=\"Dhule\">Dhule<\/option><option value=\"Jalgaon\">Jalgaon<\/option><option value=\"Kalyan\">Kalyan<\/option><option value=\"Karli\">Karli<\/option><option value=\"Kolhapur\">Kolhapur<\/option><option value=\"Mahabaleshwar\">Mahabaleshwar<\/option><option value=\"Malegaon\">Malegaon<\/option><option value=\"Matheran\">Matheran<\/option><option value=\"Mumbai\">Mumbai<\/option><option value=\"Nagpur\">Nagpur<\/option><option value=\"Nanded\">Nanded<\/option><option value=\"Nashik\">Nashik<\/option><option value=\"Osmanabad\">Osmanabad<\/option><option value=\"Pandharpur\">Pandharpur<\/option><option value=\"Parbhani\">Parbhani<\/option><option value=\"Pune\">Pune<\/option><option value=\"Ratnagiri\">Ratnagiri<\/option><option value=\"Sangli\">Sangli<\/option><option value=\"Satara\">Satara<\/option><option value=\"Sevagram\">Sevagram<\/option><option value=\"Solapur\">Solapur<\/option><option value=\"Thane\">Thane<\/option><option value=\"Ulhasnagar\">Ulhasnagar<\/option><option value=\"Vasai-Virar\">Vasai-Virar<\/option><option value=\"Wardha\">Wardha<\/option><option value=\"Yavatmal\">Yavatmal<\/option><option value=\"Imphal\">Imphal<\/option><option value=\"Cherrapunji\">Cherrapunji<\/option><option value=\"Shillong\">Shillong<\/option><option value=\"Aizawl\">Aizawl<\/option><option value=\"Lunglei\">Lunglei<\/option><option value=\"Kohima\">Kohima<\/option><option value=\"Mon\">Mon<\/option><option value=\"Phek\">Phek<\/option><option value=\"Wokha\">Wokha<\/option><option value=\"Zunheboto\">Zunheboto<\/option><option value=\"Balangir\">Balangir<\/option><option value=\"Baleshwar\">Baleshwar<\/option><option value=\"Baripada\">Baripada<\/option><option value=\"Bhubaneshwar\">Bhubaneshwar<\/option><option value=\"Brahmapur\">Brahmapur<\/option><option value=\"Cuttack\">Cuttack<\/option><option value=\"Dhenkanal\">Dhenkanal<\/option><option value=\"Keonjhar\">Keonjhar<\/option><option value=\"Konark\">Konark<\/option><option value=\"Koraput\">Koraput<\/option><option value=\"Paradip\">Paradip<\/option><option value=\"Phulabani\">Phulabani<\/option><option value=\"Puri\">Puri<\/option><option value=\"Sambalpur\">Sambalpur<\/option><option value=\"Udayagiri\">Udayagiri<\/option><option value=\"Karaikal\">Karaikal<\/option><option value=\"Mahe\">Mahe<\/option><option value=\"Puducherry\">Puducherry<\/option><option value=\"Yanam\">Yanam<\/option><option value=\"Amritsar\">Amritsar<\/option><option value=\"Batala\">Batala<\/option><option value=\"Chandigarh\">Chandigarh<\/option><option value=\"Faridkot\">Faridkot<\/option><option value=\"Firozpur\">Firozpur<\/option><option value=\"Gurdaspur\">Gurdaspur<\/option><option value=\"Hoshiarpur\">Hoshiarpur<\/option><option value=\"Jalandhar\">Jalandhar<\/option><option value=\"Kapurthala\">Kapurthala<\/option><option value=\"Ludhiana\">Ludhiana<\/option><option value=\"Nabha\">Nabha<\/option><option value=\"Patiala\">Patiala<\/option><option value=\"Rupnagar\">Rupnagar<\/option><option value=\"Sangrur\">Sangrur<\/option><option value=\"Abu\">Abu<\/option><option value=\"Ajmer\">Ajmer<\/option><option value=\"Alwar\">Alwar<\/option><option value=\"Amer\">Amer<\/option><option value=\"Barmer\">Barmer<\/option><option value=\"Beawar\">Beawar<\/option><option value=\"Bharatpur\">Bharatpur<\/option><option value=\"Bhilwara\">Bhilwara<\/option><option value=\"Bikaner\">Bikaner<\/option><option value=\"Bundi\">Bundi<\/option><option value=\"Chittaurgarh\">Chittaurgarh<\/option><option value=\"Churu\">Churu<\/option><option value=\"Dhaulpur\">Dhaulpur<\/option><option value=\"Dungarpur\">Dungarpur<\/option><option value=\"Ganganagar\">Ganganagar<\/option><option value=\"Hanumangarh\">Hanumangarh<\/option><option value=\"Jaipur\">Jaipur<\/option><option value=\"Jaisalmer\">Jaisalmer<\/option><option value=\"Jalor\">Jalor<\/option><option value=\"Jhalawar\">Jhalawar<\/option><option value=\"Jhunjhunu\">Jhunjhunu<\/option><option value=\"Jodhpur\">Jodhpur<\/option><option value=\"Kishangarh\">Kishangarh<\/option><option value=\"Kota\">Kota<\/option><option value=\"Merta\">Merta<\/option><option value=\"Nagaur\">Nagaur<\/option><option value=\"Nathdwara\">Nathdwara<\/option><option value=\"Pali\">Pali<\/option><option value=\"Phalodi\">Phalodi<\/option><option value=\"Pushkar\">Pushkar<\/option><option value=\"Sawai Madhopur\">Sawai Madhopur<\/option><option value=\"Shahpura\">Shahpura<\/option><option value=\"Sikar\">Sikar<\/option><option value=\"Sirohi\">Sirohi<\/option><option value=\"Tonk\">Tonk<\/option><option value=\"Udaipur\">Udaipur<\/option><option value=\"Gangtok\">Gangtok<\/option><option value=\"Gyalsing\">Gyalsing<\/option><option value=\"Lachung\">Lachung<\/option><option value=\"Mangan\">Mangan<\/option><option value=\"Arcot\">Arcot<\/option><option value=\"Chengalpattu\">Chengalpattu<\/option><option value=\"Chennai\">Chennai<\/option><option value=\"Chidambaram\">Chidambaram<\/option><option value=\"Coimbatore\">Coimbatore<\/option><option value=\"Cuddalore\">Cuddalore<\/option><option value=\"Dharmapuri\">Dharmapuri<\/option><option value=\"Dindigul\">Dindigul<\/option><option value=\"Erode\">Erode<\/option><option value=\"Kanchipuram\">Kanchipuram<\/option><option value=\"Kanniyakumari\">Kanniyakumari<\/option><option value=\"Kodaikanal\">Kodaikanal<\/option><option value=\"Kumbakonam\">Kumbakonam<\/option><option value=\"Madurai\">Madurai<\/option><option value=\"Mamallapuram\">Mamallapuram<\/option><option value=\"Nagappattinam\">Nagappattinam<\/option><option value=\"Nagercoil\">Nagercoil<\/option><option value=\"Palayankottai\">Palayankottai<\/option><option value=\"Pudukkottai\">Pudukkottai<\/option><option value=\"Rajapalaiyam\">Rajapalaiyam<\/option><option value=\"Ramanathapuram\">Ramanathapuram<\/option><option value=\"Salem\">Salem<\/option><option value=\"Thanjavur\">Thanjavur<\/option><option value=\"Tiruchchirappalli\">Tiruchchirappalli<\/option><option value=\"Tirunelveli\">Tirunelveli<\/option><option value=\"Tiruppur\">Tiruppur<\/option><option value=\"Tuticorin\">Tuticorin<\/option><option value=\"Udhagamandalam\">Udhagamandalam<\/option><option value=\"Vellore\">Vellore<\/option><option value=\"Hyderabad\">Hyderabad<\/option><option value=\"Karimnagar\">Karimnagar<\/option><option value=\"Khammam\">Khammam<\/option><option value=\"Mahbubnagar\">Mahbubnagar<\/option><option value=\"Nizamabad\">Nizamabad<\/option><option value=\"Sangareddi\">Sangareddi<\/option><option value=\"Warangal\">Warangal<\/option><option value=\"Agartala\">Agartala<\/option><option value=\"Agra\">Agra<\/option><option value=\"Aligarh\">Aligarh<\/option><option value=\"Amroha\">Amroha<\/option><option value=\"Ayodhya\">Ayodhya<\/option><option value=\"Azamgarh\">Azamgarh<\/option><option value=\"Bahraich\">Bahraich<\/option><option value=\"Ballia\">Ballia<\/option><option value=\"Banda\">Banda<\/option><option value=\"Bara Banki\">Bara Banki<\/option><option value=\"Bareilly\">Bareilly<\/option><option value=\"Basti\">Basti<\/option><option value=\"Bijnor\">Bijnor<\/option><option value=\"Bithur\">Bithur<\/option><option value=\"Budaun\">Budaun<\/option><option value=\"Bulandshahr\">Bulandshahr<\/option><option value=\"Deoria\">Deoria<\/option><option value=\"Etah\">Etah<\/option><option value=\"Etawah\">Etawah<\/option><option value=\"Faizabad\">Faizabad<\/option><option value=\"Farrukhabad-cum-Fatehgarh\">Farrukhabad-cum-Fatehgarh<\/option><option value=\"Fatehpur\">Fatehpur<\/option><option value=\"Fatehpur Sikri\">Fatehpur Sikri<\/option><option value=\"Ghaziabad\">Ghaziabad<\/option><option value=\"Ghazipur\">Ghazipur<\/option><option value=\"Gonda\">Gonda<\/option><option value=\"Gorakhpur\">Gorakhpur<\/option><option value=\"Hamirpur\">Hamirpur<\/option><option value=\"Hardoi\">Hardoi<\/option><option value=\"Hathras\">Hathras<\/option><option value=\"Jalaun\">Jalaun<\/option><option value=\"Jaunpur\">Jaunpur<\/option><option value=\"Jhansi\">Jhansi<\/option><option value=\"Kannauj\">Kannauj<\/option><option value=\"Kanpur\">Kanpur<\/option><option value=\"Lakhimpur\">Lakhimpur<\/option><option value=\"Lalitpur\">Lalitpur<\/option><option value=\"Lucknow\">Lucknow<\/option><option value=\"Mainpuri\">Mainpuri<\/option><option value=\"Mathura\">Mathura<\/option><option value=\"Meerut\">Meerut<\/option><option value=\"Mirzapur-Vindhyachal\">Mirzapur-Vindhyachal<\/option><option value=\"Moradabad\">Moradabad<\/option><option value=\"Muzaffarnagar\">Muzaffarnagar<\/option><option value=\"Partapgarh\">Partapgarh<\/option><option value=\"Pilibhit\">Pilibhit<\/option><option value=\"Prayagraj\">Prayagraj<\/option><option value=\"Rae Bareli\">Rae Bareli<\/option><option value=\"Rampur\">Rampur<\/option><option value=\"Saharanpur\">Saharanpur<\/option><option value=\"Sambhal\">Sambhal<\/option><option value=\"Shahjahanpur\">Shahjahanpur<\/option><option value=\"Sitapur\">Sitapur<\/option><option value=\"Sultanpur\">Sultanpur<\/option><option value=\"Tehri\">Tehri<\/option><option value=\"Varanasi\">Varanasi<\/option><option value=\"Almora\">Almora<\/option><option value=\"Dehra Dun\">Dehra Dun<\/option><option value=\"Haridwar\">Haridwar<\/option><option value=\"Mussoorie\">Mussoorie<\/option><option value=\"Nainital\">Nainital<\/option><option value=\"Pithoragarh\">Pithoragarh<\/option><option value=\"Alipore\">Alipore<\/option><option value=\"Alipur Duar\">Alipur Duar<\/option><option value=\"Asansol\">Asansol<\/option><option value=\"Baharampur\">Baharampur<\/option><option value=\"Bally\">Bally<\/option><option value=\"Balurghat\">Balurghat<\/option><option value=\"Bankura\">Bankura<\/option><option value=\"Baranagar\">Baranagar<\/option><option value=\"Barasat\">Barasat<\/option><option value=\"Barrackpore\">Barrackpore<\/option><option value=\"Basirhat\">Basirhat<\/option><option value=\"Bhatpara\">Bhatpara<\/option><option value=\"Bishnupur\">Bishnupur<\/option><option value=\"Budge Budge\">Budge Budge<\/option><option value=\"Burdwan\">Burdwan<\/option><option value=\"Chandernagore\">Chandernagore<\/option><option value=\"Darjiling\">Darjiling<\/option><option value=\"Diamond Harbour\">Diamond Harbour<\/option><option value=\"Dum Dum\">Dum Dum<\/option><option value=\"Durgapur\">Durgapur<\/option><option value=\"Halisahar\">Halisahar<\/option><option value=\"Haora\">Haora<\/option><option value=\"Hugli\">Hugli<\/option><option value=\"Ingraj Bazar\">Ingraj Bazar<\/option><option value=\"Jalpaiguri\">Jalpaiguri<\/option><option value=\"Kalimpong\">Kalimpong<\/option><option value=\"Kamarhati\">Kamarhati<\/option><option value=\"Kanchrapara\">Kanchrapara<\/option><option value=\"Kharagpur\">Kharagpur<\/option><option value=\"Koch Bihar\">Koch Bihar<\/option><option value=\"Kolkata\">Kolkata<\/option><option value=\"Krishnanagar\">Krishnanagar<\/option><option value=\"Malda\">Malda<\/option><option value=\"Midnapore\">Midnapore<\/option><option value=\"Murshidabad\">Murshidabad<\/option><option value=\"Navadwip\">Navadwip<\/option><option value=\"Palashi\">Palashi<\/option><option value=\"Panihati\">Panihati<\/option><option value=\"Purulia\">Purulia<\/option><option value=\"Raiganj\">Raiganj<\/option><option value=\"Santipur\">Santipur<\/option><option value=\"Shantiniketan\">Shantiniketan<\/option><option value=\"Shrirampur\">Shrirampur<\/option><option value=\"Siliguri\">Siliguri<\/option><option value=\"Siuri\">Siuri<\/option><option value=\"Tamluk\">Tamluk<\/option><option value=\"Titagarh\">Titagarh<\/option><option value=\"Others Cities\">Others Cities<\/option><\/select><\/span><\/b><\/label>\n<\/p>\n<p>[group If_required_Pursuing_Cities]<br>\n<label><b>28A.Mention your School City Name: (If Your City\/Town not in above list)<\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"If_required_pursuing_Cities\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"If_required_pursuing_Cities\"><\/span><br>\n<\/label><br>\n[\/group]\n<\/p>\n<p><label><b>29. Pincode Of School \/ College \/ Institute (PRESENTLY PURSUING)\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PursuSchoolPincode\"><input size=\"40\" maxlength=\"6\" minlength=\"4\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PursuSchoolPincode\"><\/span><\/b><\/label>\n<\/p>\n<p><label><b>30.Mobile No of Your School (PRESENTLY PURSUING)<\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PursuSchoolMobile\"><input size=\"40\" maxlength=\"10\" minlength=\"9\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"PursuSchoolMobile\"><\/span><\/label>\n<\/p>\n<p><label><b>31.Tel. No. (with STD Code) (PRESENTLY PURSUING)<\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Pursu_Tele\"><input size=\"40\" maxlength=\"12\" minlength=\"9\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Pursu_Tele\"><\/span><\/label>\n<\/p>\n<p><label> <b>32.Class \/ Course (PRESENTLY PURSUING)<\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ClassPresent\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ClassPresent\"><\/span><\/label><br>\n<label> <b>33.Course Duration (No, of Years) PRESENTLY PURSUING <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CourseDuration\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CourseDuration\"><\/span><\/label><br>\n<label> <b>34.Subjects (PRESENTLY PURSUING) <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split> <\/label><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-22\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Maths \/ Mathematics\"><span class=\"wpcf7-list-item-label\">Maths \/ Mathematics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Algebra\"><span class=\"wpcf7-list-item-label\">Algebra<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Geometry\"><span class=\"wpcf7-list-item-label\">Geometry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Biology\"><span class=\"wpcf7-list-item-label\">Biology<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Physics\"><span class=\"wpcf7-list-item-label\">Physics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Chemistry\"><span class=\"wpcf7-list-item-label\">Chemistry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Geography\"><span class=\"wpcf7-list-item-label\">Geography<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"History\"><span class=\"wpcf7-list-item-label\">History<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Citizenship\"><span class=\"wpcf7-list-item-label\">Citizenship<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Physical Education (P.E)\"><span class=\"wpcf7-list-item-label\">Physical Education (P.E)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Business Studies\"><span class=\"wpcf7-list-item-label\">Business Studies<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Home Economics\"><span class=\"wpcf7-list-item-label\">Home Economics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Trigonometry\"><span class=\"wpcf7-list-item-label\">Trigonometry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Statistics\"><span class=\"wpcf7-list-item-label\">Statistics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"English\"><span class=\"wpcf7-list-item-label\">English<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Hindi\"><span class=\"wpcf7-list-item-label\">Hindi<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Bengali\"><span class=\"wpcf7-list-item-label\">Bengali<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Computer Application\"><span class=\"wpcf7-list-item-label\">Computer Application<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Statistical\"><span class=\"wpcf7-list-item-label\">Statistical<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Economics\"><span class=\"wpcf7-list-item-label\">Economics<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Computer Science\"><span class=\"wpcf7-list-item-label\">Computer Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Science\"><span class=\"wpcf7-list-item-label\">Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Sanskrit\"><span class=\"wpcf7-list-item-label\">Sanskrit<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Accounts\"><span class=\"wpcf7-list-item-label\">Accounts<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Social science\"><span class=\"wpcf7-list-item-label\">Social science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Physical Science\"><span class=\"wpcf7-list-item-label\">Physical Science<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Urdu\"><span class=\"wpcf7-list-item-label\">Urdu<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Others Subject\"><span class=\"wpcf7-list-item-label\">Others Subject<\/span><\/label><\/span><\/span><\/span><br>\n[group PursuingOtherSubjects]<br>\n<label> <b>34A.If Others Subject, Please Specify (Pursuing) <\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SubjectPursuing\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"SubjectPursuing\"><\/span><\/label>[\/group]<br>\n<!---------------------------------- END Student's Presently pursuing Information---------->\n<\/p>\n<p><label> <b>35.Economic (Financial Standing) (Enclose Copy of Last Income Tax Return Field or else any proof of income document.) <\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split><br>\n<\/label><br>\n<label> <b>35A. Parents Annual Income Rs <\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"AnnualIncome\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"AnnualIncome\"><\/span><\/label><br>\n<label> <b>35B. If Parents are Income Tax Assess, then PAN No. of anyone <\/b><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PANNo\"><input size=\"40\" maxlength=\"10\" minlength=\"6\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PANNo\"><\/span><\/label><br>\n<label> <b>36. Is Reservation applicable (Optional): If yes, Then PL Check in the related box &amp; enclosed the copy of certificate\/documentary evidence if any :-<\/b><br>\n<\/label><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-ReservationApplication\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-ReservationApplication[]\" value=\"Special Category- Handicapped\"><span class=\"wpcf7-list-item-label\">Special Category- Handicapped<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-ReservationApplication[]\" value=\"Excellence extra- curricular \nactivities like sports, NCC B certificate holder , debating, \ndramatics &amp; social services\"><span class=\"wpcf7-list-item-label\">Excellence extra- curricular \nactivities like sports, NCC B certificate holder , debating, \ndramatics &amp; social services<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-ReservationApplication[]\" value=\"Economically weakersection \u2013 of \nthose students, whose presents annual income is not more than Rs, 1,20,000\/-\"><span class=\"wpcf7-list-item-label\">Economically weakersection \u2013 of \nthose students, whose presents annual income is not more than Rs, 1,20,000\/-<\/span><\/label><\/span><\/span><\/span><br>\n<br>\n<label> <b>37. CHECKLIST \u2013 for enclosures, PL tick,(Pl UPLOAD YOUR DETAILS )\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split> :- <\/b><\/label><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-683new\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-683new[]\" value=\"Copy of marksheet\"><span class=\"wpcf7-list-item-label\">Copy of marksheet<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-683new[]\" value=\"Copy of Proof of Income document\"><span class=\"wpcf7-list-item-label\">Copy of Proof of Income document<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-683new[]\" value=\"Copy of certificate providing reservation\"><span class=\"wpcf7-list-item-label\">Copy of certificate providing reservation<\/span><\/label><\/span><\/span><\/span><br>\n<br>\n<label> <b> 38. Please Upload your Hardcopy Of the Marksheet, Proof Of Income Document, Special Categories Certificate (File Size 10mb):-<\/b>\n\t\t<split style=\"color: red\" ;>*\n\t\t<\/split> <span class=\"wpcf7-form-control-wrap\" data-name=\"Certificate\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" multiple data-name=\"Certificate\" data-type=\"jpg|jpeg|png|gif|xcel|word|pdf\" data-limit=\"10097152\" data-min=\"1\" data-max=\"10\" data-id=\"5\" data-version=\"free version 1.3.9.8\" accept=\".jpg, .jpeg, .png, .gif, .xcel, .word, .pdf\"><\/span><\/label><br>\n<label> <b>39. DECLARATION\n\t\t\t<split style=\"color: red\" ;>*\n\t\t\t<\/split><\/b><\/label><br>\n<label> <b>I\/We hereby declared that the information provided is true to the best of my\/our knowledge and nothing is concealed \/misrepresented. JM SETHIA CHARITABLE TRUST Management\u2019s decision will be final and decisive for selecting and granting Scholarships. In case Of any discrepancy found at any point in time. I \/ We would be responsible for the cancellation of the Scholarship &amp;refund of the money received on this behalf. I\/We further state that no other scholarship is claimed from any other sources. I would be entitled to the Scholarship as long as I a enrolled in the above-mentioned course \/ College \/institution. I shall furnish a quarterly declaration continuity certificate obtained from the Principal \/ Head \/ of the Institute &amp; authentication about the utilization of the scholarship amount every failing which scholarship amount will be stopped.<\/b><br>\n<\/label><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"accept-this\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accept-this\" value=\"1\" aria-invalid=\"false\"><\/span><\/span><\/span> I\/We accept the terms &amp; condition<br>\n<br>\n<!--<label> <b>Please download this <a href=\"http:\/\/www.jmstrust.com\/recommendation-form.html\">Recommendation form <\/a> <a href=\"http:\/\/www.jmstrust.com\/recommendation-form.html\">www.jmstrust.com\/recommendation-form.html<\/a>,get it attached it from your Headmaster \/ Principal\/Head of the Institution , and then  submit your form below<\/label>\n<\/br>\n<label> Kindly upload the Recommendation Form Here <span class=\"wpcf7-form-control-wrap\" data-name=\"file-608\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.xcel,.word\" aria-invalid=\"false\" type=\"file\" name=\"file-608\" \/><\/span><\/label>--><br>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\">\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t<\/body>","protected":false},"excerpt":{"rendered":"<p>(To: JM Sethia Charitable trust of 16, Ganesh Chandra Avenue, Kolkata-700013,West Bengal, INDIA, fon:\u00a0+91-33-2236 0368,4040 1300, mob : +91-9339793153, West Bengal, INDIA, e-mail: jms_trust@yahoo.in, website: www.jmstrust.com) \u00a0 \u00a0Note :\u00a0 INSTRUCTION :- Do not Fillip application form repeatedly. Form Should be Fill up in English letters only (Do not use any regional language). Scholarship scheme is [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":9,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/template-full-width.php","meta":{"om_disable_all_campaigns":false,"footnotes":""},"class_list":["post-6","page","type-page","status-publish","has-post-thumbnail","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/pages\/6","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/comments?post=6"}],"version-history":[{"count":205,"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/pages\/6\/revisions"}],"predecessor-version":[{"id":3398,"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/pages\/6\/revisions\/3398"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/media\/9"}],"wp:attachment":[{"href":"https:\/\/jmstrust.com\/enrolment\/wp-json\/wp\/v2\/media?parent=6"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}