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Search Application Form No.
Apply for CM Welfare (12000/-)
Application Form For New Enrollment
1. Name of Candidate
*
Shri
Ku
Smt
Mrs
आवेदक का नाम
श्री
कु
श्रीमती
सुश्री
2. Father/Husband Name
*
Shri
आवेदक के पिता/पति का नाम
श्री
3. Mother's Name
*
Smt
Mrs
आवेदक की माता का नाम
श्रीमती
सुश्री
Gender
M
F
T
4. Caste
*
GEN
OBC
SC
ST
5. Date of Birth
*
6. Aadhar No
*
7. L.L.B. Final Passing Year
*
8. Blood Group
A+
B+
AB
O+
9. Full Address for Correspondance
*
City
*
AGARMALWA
AGARMALWA
AJAYGARH
AJAYGARH
ALIRAJPUR
ALIRAJPUR
ALOTE
ALOTE
AMARPATAN
AMARPATAN
AMARWADA
AMARWADA
AMBAH
AMBAH
AMLA
AMLA
ANJAD
ANJAD
ANOOPPUR
ANOOPPUR
ARON
ARON
ASHOK-NAGAR
ASHOK-NAGAR
ASHTA
ASHTA
BABAI
BABAI
BADAMALEHRA
BADAMALEHRA
BADNAGAR
BADNAGAR
BADNAWAR
BADNAWAR
BADWAHA
BADWAHA
BADWANI
BADWANI
BAGLI
BAGLI
BAHORIBAND
BAHORIBAND
BAIHAR
BAIHAR
BALAGHAT
BALAGHAT
BANDA
BANDA
BARELI
BARELI
BARHI
BARHI
BARHI
BARHI
BARHI
BARHI
BARHI
BEGUMGANJ
BEGUMGANJ
BEOHARI
BEOHARI
BERASIA
BERASIA
BETUL
BETUL
BHAINSDEHI
BHAINSDEHI
BHANDER
BHANDER
BHANPURA
BHANPURA
BHIKANGAON
BHIKANGAON
BHIND
BHIND
BHITARWAR
BHITARWAR
BHOPAL
BHOPAL
BHUA BICHIYA
BHUA BICHIYA
BIAORA
BIAORA
BIJAWAR
BIJAWAR
BINA
BINA
BUDHNI
BUDHNI
BURHANPUR
BURHANPUR
BURHAR
BURHAR
CHANCHODA
CHANCHODA
CHANDERI
CHANDERI
CHAPARA
CHAPARA
CHHATARPUR
CHHATARPUR
CHHINDWARA
CHHINDWARA
CHITRANGI
CHITRANGI
CHOURAI
CHURHAT
DABRA
DAMOH
DATIA
DEORI
DEOSAR
DEPALPUR
DEWAS
DHAR
DHARAMPURI
DINDORI
ESHAGARH
GADARWARA
GAIRATGANJ
GANJBASODA
GARHAKOTA
GAROTH
GHANSOR
GOHAD
GOHARGANJ
GOHPARU
GOPADBANAS
GOTEGAON
GUNA
GUNOUR
GURH
GWALIOR
GYARASPUR
HANUMANA
HARDA
HARSUD
HATOD
HATTA
HOSHANGABAD
ICHHAWAR
INDORE
ISAGARH
ITARSI
JABALPUR
JAISINGHNAGAR
JAITHARI
JAITPUR
JAORA
JATARA
JAWA
JAWAD
JHABUA
JHIRANYA
JOBAT
JOURA
JUNNARDEO
KAILARAS
KALAPIPAL
KANNOD
KARELI
KARERA
KASRAWAD
KATANGI
KATNI
KESLI
KEVLARI
KHACHROUD
KHANDWA
KHANIYADHANA
KHARGONE
KHATEGAON
KHETIA
KHILCHIPUR
KHIRKAIYA
KHURAI
KOLARAS
KOTMA
KUKSHI
KURWAI
LAHAR
LAKHNADONE
LATERI
LAUNDI
LAUNDI(LAVKUSH NAGAR)
MAHESHWAR
MAHIDPUR
MAIHAR
MAIHAR
MAIHAR
MAIHAR
MAIHAR
MAJHAULI
MALHARGARH
MANASA
MANAWAR
MANDLA
MANDLESHWAR
MANDSAUR
MANGAWAN
MANPUR
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MEHGAON
MHOW
MORENA
MULTAI
MUNGAOLI
NAGDA
NAGOD
NAIGARHI
NAINPUR
NALKHEDA
NARAYANGARH
NARSINGHGARH
NARSINGHPUR
NARWAR
NASRULLAGANJ
NAWGAON
NEEMUCH
NIWARI
NIWAS
OBAIDULLAGANJ
ORCHHA
PALI
PANDHURNA
PANNA
PARASIA
PATAN
PATHARIA
PAWAI
PETLAWAD
PICHHORE
PIPARIYA
POHARI
PORSA
PUSHPRAJGARH
RAGHOGARH
RAGHURAJNAGAR
RAIPURKARCHULIYAN
RAISEN
RAJENDRAGRAM
RAJGARH
RAJNAGAR
RAJPUR
RAMNAGAR
RAMPUR NAIKIN
RAMPURA
RAMPURBAGHELAN
RATLAM
REHLI
REWA
SABALGARH
SAGAR
SAILANA
SANAWAD
SARANGPUR
SARDARPUR
SATNA
SAUSAR
SAWER
SEHORE
SEMRIYA
SENDHWA
SEONDHA
SEONI
SEONIMALWA
SHAHDOL
SHAHGARH
SHAHNAGAR
SHAHPURA
SHAJAPUR
SHEOPURKALAN
SHIVPURI
SHUJALPUR
SIDHI
SIHORA
SILWANI
SINGRAULI
SIRMOUR
SIRONJ
SITAMAU
SOHAGPUR (HOSHANGABAD)
SOHAGPUR-SHAHDOL
SONKATCH
SUSNER
SUVASRA
TARANA
TENDUKHEDA-DAMOH
TENDUKHEDA-NARSINGHPUR
TEONTHER
THANDLA
TIKAMGARH
TIMARNI
TONK-KHURD
UDAIPURA
UJJAIN
UMARIA
UNCHEHARA
VIDISHA
VIJAYPUR
VIJAYRAGHAVGARH
WAIDHAN
WARASEONI
ZIRAPUR
Pin Code
*
10. Tele/Mobile No.
*
Mobile No.
11. Email
12. Place of Practice
*
AGARMALWA
AGARMALWA
AJAYGARH
AJAYGARH
ALIRAJPUR
ALIRAJPUR
ALOTE
ALOTE
AMARPATAN
AMARPATAN
AMARWADA
AMARWADA
AMBAH
AMBAH
AMLA
AMLA
ANJAD
ANJAD
ANOOPPUR
ANOOPPUR
ARON
ARON
ASHOK-NAGAR
ASHOK-NAGAR
ASHTA
ASHTA
BABAI
BABAI
BADAMALEHRA
BADAMALEHRA
BADNAGAR
BADNAGAR
BADNAWAR
BADNAWAR
BADWAHA
BADWAHA
BADWANI
BADWANI
BAGLI
BAGLI
BAHORIBAND
BAHORIBAND
BAIHAR
BAIHAR
BALAGHAT
BALAGHAT
BANDA
BANDA
BARELI
BARELI
BARHI
BARHI
BARHI
BARHI
BARHI
BARHI
BARHI
BEGUMGANJ
BEGUMGANJ
BEOHARI
BEOHARI
BERASIA
BERASIA
BETUL
BETUL
BHAINSDEHI
BHAINSDEHI
BHANDER
BHANDER
BHANPURA
BHANPURA
BHIKANGAON
BHIKANGAON
BHIND
BHIND
BHITARWAR
BHITARWAR
BHOPAL
BHOPAL
BHUA BICHIYA
BHUA BICHIYA
BIAORA
BIAORA
BIJAWAR
BIJAWAR
BINA
BINA
BUDHNI
BUDHNI
BURHANPUR
BURHANPUR
BURHAR
BURHAR
CHANCHODA
CHANCHODA
CHANDERI
CHANDERI
CHAPARA
CHAPARA
CHHATARPUR
CHHATARPUR
CHHINDWARA
CHHINDWARA
CHITRANGI
CHITRANGI
CHOURAI
CHURHAT
DABRA
DAMOH
DATIA
DEORI
DEOSAR
DEPALPUR
DEWAS
DHAR
DHARAMPURI
DINDORI
ESHAGARH
GADARWARA
GAIRATGANJ
GANJBASODA
GARHAKOTA
GAROTH
GHANSOR
GOHAD
GOHARGANJ
GOHPARU
GOPADBANAS
GOTEGAON
GUNA
GUNOUR
GURH
GWALIOR
GYARASPUR
HANUMANA
HARDA
HARSUD
HATOD
HATTA
HOSHANGABAD
ICHHAWAR
INDORE
ISAGARH
ITARSI
JABALPUR
JAISINGHNAGAR
JAITHARI
JAITPUR
JAORA
JATARA
JAWA
JAWAD
JHABUA
JHIRANYA
JOBAT
JOURA
JUNNARDEO
KAILARAS
KALAPIPAL
KANNOD
KARELI
KARERA
KASRAWAD
KATANGI
KATNI
KESLI
KEVLARI
KHACHROUD
KHANDWA
KHANIYADHANA
KHARGONE
KHATEGAON
KHETIA
KHILCHIPUR
KHIRKAIYA
KHURAI
KOLARAS
KOTMA
KUKSHI
KURWAI
LAHAR
LAKHNADONE
LATERI
LAUNDI
LAUNDI(LAVKUSH NAGAR)
MAHESHWAR
MAHIDPUR
MAIHAR
MAIHAR
MAIHAR
MAIHAR
MAIHAR
MAJHAULI
MALHARGARH
MANASA
MANAWAR
MANDLA
MANDLESHWAR
MANDSAUR
MANGAWAN
MANPUR
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MAUGANJ
MEHGAON
MHOW
MORENA
MULTAI
MUNGAOLI
NAGDA
NAGOD
NAIGARHI
NAINPUR
NALKHEDA
NARAYANGARH
NARSINGHGARH
NARSINGHPUR
NARWAR
NASRULLAGANJ
NAWGAON
NEEMUCH
NIWARI
NIWAS
OBAIDULLAGANJ
ORCHHA
PALI
PANDHURNA
PANNA
PARASIA
PATAN
PATHARIA
PAWAI
PETLAWAD
PICHHORE
PIPARIYA
POHARI
PORSA
PUSHPRAJGARH
RAGHOGARH
RAGHURAJNAGAR
RAIPURKARCHULIYAN
RAISEN
RAJENDRAGRAM
RAJGARH
RAJNAGAR
RAJPUR
RAMNAGAR
RAMPUR NAIKIN
RAMPURA
RAMPURBAGHELAN
RATLAM
REHLI
REWA
SABALGARH
SAGAR
SAILANA
SANAWAD
SARANGPUR
SARDARPUR
SATNA
SAUSAR
SAWER
SEHORE
SEMRIYA
SENDHWA
SEONDHA
SEONI
SEONIMALWA
SHAHDOL
SHAHGARH
SHAHNAGAR
SHAHPURA
SHAJAPUR
SHEOPURKALAN
SHIVPURI
SHUJALPUR
SIDHI
SIHORA
SILWANI
SINGRAULI
SIRMOUR
SIRONJ
SITAMAU
SOHAGPUR (HOSHANGABAD)
SOHAGPUR-SHAHDOL
SONKATCH
SUSNER
SUVASRA
TARANA
TENDUKHEDA-DAMOH
TENDUKHEDA-NARSINGHPUR
TEONTHER
THANDLA
TIKAMGARH
TIMARNI
TONK-KHURD
UDAIPURA
UJJAIN
UMARIA
UNCHEHARA
VIDISHA
VIJAYPUR
VIJAYRAGHAVGARH
WAIDHAN
WARASEONI
ZIRAPUR
13. Name of Nominee
*
Shri
Ku
Smt
Mrs
उत्तराधिकारी का नाम
श्री
कु
श्रीमती
सुश्री
14. Relation
*
Father
Mother
Husband
Wife
Brother
Sister
Other
15. AIBE Exam Passed
No
Yes/option>
16. Applicant Photo
17. Applicant Signature
18. Caste Cerificate(Only for SC/ST)
19. HSC (10
th
) Board
20. HSSC (12
th
) Board
21. UG (Graduation) University
22. UG (LLb/BALLb) University
23. Any Criminal Case
No
Yes-Dispose
Yes-Pending
मेरे द्वारा यह घोषित किया जाता है कि इस आवेदन पत्र में वर्णित किये गए सभी तथ्य एवं जानकारी सत्य है एवं प्रत्तुत किये गए दस्तावेज वास्तविक है। यदि कोई भी तथ्य , जानकारी , दस्तावेज गलत पाया जाये तो मेरा नाम अधिवक्ता नामावली से काट दिया जाये।
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