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Nayta Patel Samaj M.P.
संयुक्त परिवार एवं सदस्य पंजीयन प्रपत्र (Combined Form)
Fill family details and add all members below.
Section 1: Family Location (स्थान विवरण)
राज्य (State)
Select State
Madhya Pradesh
जिला (District)
Select District
Ujjain
Ratlam
Indore
Dhar
Dewas
तहसील (Tehsil)
Select Tehsil
Badnagar
Depalpur
Dewas
Dhar
Ghattiya
Indore
Khachrod
Mahu
Pithampur
Ratlam
Sanwer
Sonkach
Tarana
Tonk Khurd
Ujjain
Unhel
Badnawar
Other (New Entry)
ग्राम/कस्बा/शहर (Village/Town)
Select Village
Agrod
Panthmundla (Lakkad)
Ant
Antraliya
Dewar
Kachnariya
Hapa Kheda
Jetpura Dewas
Bapcha
Pitwali
Pitwala
Akiya
Tonk Khurd
Polaye Nayta
Maddukhedi
Habankhedi
Gadai Pipliya
Gandawal
Silawti
Siya Dewas
Siyapura
Satwaldi
Gujjar Bapcha
Puwards Nayta
Panch Talab
Bhanoli
Vijayganj Mandi
Dumni
Kheda
Sumrakhedi
Dhannad
Gunawad
Updi
Antrai
Nawasa
Khiledi
Gowla
Baloda
Kot Bhidoda
Kalukhedi Dhar
Bamansutta
Nogawa
Nagora
Pankhedi
Palwada
Piliya Dhar
Kushawada
Mushawada
Magajpura Dhar
Tajpur Dhar
Nalcha
Babeda
Chillur
Tajkhedi
Kherod
Mudka
Gulmohar Dhar
Machhu Khedi
Ghata Billod
Kungara
Chenpura Dhar
Bangla Billod
Jhadi Baroda
Chimli
Solsindi
Solsinda
Rudrakhiya
Dharmat
Chandankhedi
Chandrawati Ganj
Rangrej
Khatediya
Jalwai Hasalpur
Hasalpur
Siyada
Kavti
Sonwaye
Jhkhu Khedi
Khareli
Khajrana
Khajrani
Kadwa
Patwakhedi
Dharmpuri
Jetpura Dharmpuri
Biloda
Baank
Magarkheda
Nayta Mundla (Patthar)
Piplai
Jamodi
Khudel
Sanawdiya
Khakla
Makodiya
Puwarda Bakshi Ji
Kavti Baldi
Mahu
Santer
Sinhasa
Bajrangpura
Bhokaradiya
Saraye
Malwasa
Jaora
Dodiya
Narsali
Narsala
Kaliyadeh
Badarkha Babaji
Badarkha Berasia
Najarpur
Ganai
Ramgad
Dhatrawda
Biyawra
Kaitha
Khrent
Narwar
Datana
Matana
Kasampur
Chikhli
Madawdi
Mominpura
Kanjad Phatak
Khokriya
Bhomalwas
Umriya
Khetiya Khedi
Jarkhoda
Kadcha Fatak
Hanskhedi
Gamdi
Kolukhedi - Kaloda
Runija
Madhupura
Tokra
Bhat Pachlana
Aslawda
Kotdi
Narela
Nariya Bagana
Pingleshwar
Jawasiya
Harniya Khedi Ujjain
Jandla
Kalmoda
Semliya
Kachi Badoda
Garakhedi
Udana
Mithi Khedi
Narsing Gadh
Harniya Khedi Mahu
Sanwer
Other (New Entry)
ग्राम कोड (Village Code)
सर्वे दिनांक (Survey Date)
Section 2: Head Details (मुखिया विवरण)
मुखिया का नाम (Head Name)
पिता/पति का नाम (Father/Husband Name)
गौत्र (Gotra)
Select Gotra
Monpura
Veermat
Gamua
Khedayela
Kaba
Saligat
Karichna
Babayat
Samawna
Lunsat
Kapatla
Waghela
Ajjansara
Nagarsa
Amarvela
Chawda
Dendriya
Sarkeja
Gouri
Khilchi
Moidanta
Agevan
Bhedayat
Other
ईमेल (Head Email)
मोबाइल 1 (Mobile 1)
मोबाइल 2 (Optional)
व्हाट्सएप नंबर (Optional)
Section 3: Address (पता)
पूरा पता (Full Address)
Section 4: Family Documents (परिवार दस्तावेज)
समग्र ID
राशन कार्ड
Section 5: Facilities (सुविधाएं)
आयुष्मान कार्ड
No
Yes
शौचालय
Yes
No
Family Members (परिवार के सदस्य)
Add Member
Section 6: Summary & Signature
कुल सदस्य
पुरुष
महिला
बच्चे (Boys)
बच्चियाँ (Girls)
टिप्पणी (Remarks)
हस्ताक्षर (Signature)
Submit Combined Form (जमा करें)
Member
1
Name
Relation
Select
Self (स्वयं)
Wife (पत्नी)
Son (पुत्र)
Grand-Son
Daughter (पुत्री)
Grand-Daughter
Daughter-in-law
Grand-Daughter-in-law
Son-in-law
Grand-Son-in-law
Father (पिता)
Mother (माता)
Grand-Father
Grand-Mother
Father in Law (ससुर)
Mother in Law (सास)
Grand-Father in Law (परदादा/नाना ससुर)
Grand-Mother in Law (परदादी/नानी सास)
Brother (भाई)
Sister (बहन)
Other
Gender
Select
Male
Female
Other
DOB
Age
Marital Status
Single
Married
Divorced
Widowed
Education
Select
Illiterate
Primary
Middle
High School
Higher Secondary
Graduate
Post Graduate
Hafiz
Aalim
Qari
Mufti
Occupation
ID Proof Type
None
Aadhar
Voter ID
Other
ID Number
Health Issue (Optional)
Health Status