Member Registration Form

Enrolment No
Fill in
Full Name
Type Your Full Name
Fill in
Short Name of Advocate
Fill in
Local Language
  • - select a option -
  • Odia
  • Hindi
  • Telugu
  • English
  • Tamil
  • Kanada
- select a option -
Field is required!
Date of Birth
Select a date
Fill in
Gender
Field is required!
Address of the Advocate
Type Your Address..
Field is required!
Address of Advocate in Local Language
Type Your Address..
Fill in
Your Mobile Number
Mobile Number
Please Type 10 digit mobile number
Email
Your E-mail Address
Field is required!
Whtatsapp Number (if Any )
Whtatsapp_Number
Please Type 10 digit mobile number
Your Landline Number
Landline_Number
Please Type 10 digit mobile number
Pin Code
Pin code
Field is required!
Fax No
Enter Fax Number
Please Type 10 digit mobile number
District
District
Field is required!
Office Address of Advocate where he practices
Office Address of Advocate where he practices
Field is required!
Enter Taluka
Enter Taluka
Field is required!
Type Of Advocate
  • - select a option -
  • Individual
  • Firm
  • Company
- select a option -
Field is required!
Office Address of Advocate in Local
Office Address of Advocate in Local
Field is required!
If Firm or Company,Registration No. in BCI
If Firm or Company,Registration No. in BCI
Field is required!
Upload your Passport Photo ...
Field is required!
error: Content is protected !!