Fill in the following Form for Registration

* indicates a required field

Consumer Profile
Division*	----Select--- AED,ATHAGARH ANED,ANGUL BAED,BALUGAON BCDD-1,BHUBANESWER BCDD-2,BHUBANESWER BED,BHUBANESWER CDD-1,CUTTACK CDD-2,CUTTACK CED,CUTTACK DED,DHENKANAL JED,JAGATSINGHPUR KED,KENDRAPARA KHD, KHURDA MED,MARSHAGHAI NED,NIMAPARA NYD,NAYAGARH PDP,PARADEEP PED,PURI SED,SALIPUR TED,TALCHER
Consumer Type *	----Select--- SBM NON-SBM Know your bill types!
Consumer No.*
Select Type *	Individual    Company
First Name *
Middle Name
Last Name *
UID	----Select--- Aadhar Card Driving License PAN Card Passport Voter ID Card
Gender	----Select--- Female Male Other
Date of Birth *
Company/Organization *
Contact Person *
Date of Incorporation *
Type of Incorporation *	----Select--- Corporation Joint Venture Limited Liability Company Private Public
Security Question & Answer
Secret Question *	----Select--- What city was your father born in? What city was your mother born in? What city were you born in? What is the first name of your best childhood friend? What is the name of the first company/organization your worked for? What is the name of the hospital in which you were born? What was the name of your primary school?
Secret Answer *
Consumer Demographic Information
Address 1 *
Address 2
Village/ Town/ City *
District *	----Select--- Angul Balangir Balasore Bargarh Baudh Bhadrak Cuttack Deogarh Gajapati Ganjam Jagatsinghapur Jajpur Jharsuguda Khordha
State	Odisha
Country	INDIA
Pin Code *
Land Line Number
Mobile Number*
Alternate Contact
Email *
Consumer Miscellaneous Information
Education	----Select--- Matric Graduate Post Graduate Professional Others
Income Range(Monthly)	----Select--- Above 50,000 25,001 - 50,000 15,001 - 25,000 10,001 - 15,000 5,001 - 10,000 Upto 5,000
Occupation	----Select--- Salaried Business Self Employed Student Retired Others
MembershipProfile
Login Name *
Password *	Note: Password must be between 8 and 20 characters with at least one lower-case, one upper-case, one numeric and one special character.
Confirm Password *
Note: The fields Login Name, First Name, Last Name, Date Of Birth, Pin Code, Email Address and Security Question/Answer are required for forgot login name and forgot password process.