Care Centre Registration

Location Details

State *

District *

Sub District *

Block *

Village *

Details of Branch Head

Head Name *

Gender *

Email Id *

Mobile Number *

Owner Full Address (as per Aadhaar card) *

Office Full Address *

Pin Number *

Type of Identity Proof *

Aadhaar Number *

Bank Details

Account Holder Name *

Bank Name *

IFSC Code *

Account Number *

Create Password *

Show Password

Create Support Pin * (4 Digit Number)

Referral Registrar ID (optional)

Select Help Center Type *

Details of Nominee

Nominee Name *

Relation to ECC *

Nominee Aadhaar Number *

Nominee Mobile Number

Nominee Address

Upload Documents

Head Aadhaar Card * (Both Side)(PDF)(Max. 2MB)

Head PAN Card * (PDF)(Max. 2MB)

Cancel Cheque / Bank Details * (PDF)(Max. 2MB)

Terms & Conditions

All information provided must be accurate and truthful. Submission of false information may result in rejection or cancellation of registration.
Uploaded documents must be clear, valid, and not expired. Maximum file size is 2MB per document.
The applicant agrees to comply with all rules, regulations, and guidelines issued by Samriddh from time to time.
Samriddh reserves the right to verify all submitted information and documents before approving the registration.
The applicant is responsible for maintaining the confidentiality of their login credentials.
Any misuse of the platform or violation of terms may result in immediate suspension or termination of the account.
By submitting this form, the applicant gives consent to Samriddh to use the provided information for registration and communication purposes.

I have read and agree to the Terms & Conditions of Samriddh. I confirm that all information provided is correct and complete.

Please accept the Terms & Conditions above to enable the Submit button.

Samriddh