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Salutation *

First Name / पहला नाम *

Last Name / अंतिम नाम *

Email Id / ईमेल आयडी *

Mobile Number *

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Select State / राज्य *

Branch/शाखा *

PinCode / पिन कोड *

Agri Landholdings (In Acres)/कृषि जोत *

Other Source of Income/आय के अन्य स्रोत *

Type of Loan/ऋण का प्रकार *

Loan Amount/उधार की राशि *

Collateral Present/संपार्श्विक उपहार *

I, declare that the information I have provided is accurate & complete to the best of my knowledge. I give my consent to Ujjivan small finance bank and its representative to contact me through call/email and/or send a text through SMS.

Kisan Pragati Card

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