Apply for Residential Accomodation
I Undersignd, SAMYAK Niwas Haqh Accommodation
FullName
Phone Number
Email
Age
Gender
Please Select
Male
Female
Other
Aadhar Card
Occupation
Address
Street Address Line 2
Average Monthly Income
Family Monthly Income
Room Size *
Please Select
250 Sq.ft
350 Sq.ft
500 Sq.ft
700 Sq.ft
District
Please Select
Palghar
Raigadh
Thane
Navi Mumbai
Mumbai
Ratnagiri
Membership Fees not Refundable
Lifetime Membership 11,000/-
Transaction Details
Date
-
Month
-
Day
Year
Bank Name
Transaction Slip
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit Form
Should be Empty: