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Hindi
APPLICATION FORM FOR LEGAL AID / Grievance
Application For *: Received Through *:  
State: District: Taluka:
Nature of Legal Aid / Grievance *:  
Summary of problem for which legal aid / Grievance is sought  *:  
Applicant Name *: Upload Photograph: (gif,jpeg Image only)
In Custody From: Select Jail*:  
Father Name: Mother Name:  
Spouse Name:  
Gender *: Date of Birth:  
Phone: Mobile : Email:
Religion: Caste: Caste Certificate No.:
Occupation: Employment Details: Annual Income:
Eligibility Category*:  
Offence under which applicant has been arrested*:
Current Address *: Permanent Address:
State *: State:
District: District:
Taluka : Taluka: