CLICK HERE to download Our Application Form       Application For Ticket   From Monthly/Pooval Day Kuri 1 Name 2 Present Postal Address 3 Date of Birth(if minor, minors guardian) Day --select-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month --select-- January February March April May June July August September October November December Year --select-- 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009   Age 4 Father/Mother Name   Guardian Sri/Smt Name 5 House Name   Door No 6 Telephone 7 Father's/Mothers's/Husband's Name 8 Occupation   Monthly income/salary 9 Permanent native place   District   Taluk   Village   Desam/Kara   Pin Office 10 Name of the Nominee   Relationship   Full Address 11 E-mail ID       Gentleman, Having completely read or caused to be read full understood rules governing the conduct of the chit herein printed,a copy of which was signed and delivered to you, and which is proposed to be started from day of and assented the same. I/We Send a sum of Rs. by money order/Cheque/remittance/in cash less the discount and commision Rs. being payment of one ticket valued at Rs. due for the first instalment.I request you to allot me the ticket/s. I/We agree to any change in the date of the commencement of the chit.     * I hereby declare that the information provided by me is accurate to the best of my knowledge.