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👤 Full Name *

As per government ID · Only letters, spaces, dots and hyphens

📱 Mobile Number *

10-digit mobile number (starts with 6-9)

🗺️ State * — Select your state — Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland NCT of Delhi Odisha Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal

🏙️ District * — Select state first —

🏪 Market / Mandi * — Select district first —

🔒 Password *

At least 6 characters with one letter and one number

🔒 Confirm Password *

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