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Name of the Applicant*
Postal Pin Code*
Company*  
Email-ID*
Address* Mobile No.*

User-ID*
State* Password*
District*
Confirm Password*
Enter Captcha Code* Captcha2 Image Reload Captcha Image

 
   
Note:  1. Password length should be 6 to 20 character including at least one special character.
             2. Fields marked with (*) are mandatory.
             3. Junk/inappropriate values in profile may lead to deactivation
             4. Please use a valid E-Mail ID and mobile number in registration.
             5. Your user id, password will be sent to your registered E-Mail id
     
I agree to the terms of use of eGICCS System
     
      
   
   
 
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