Registration
Login
General Details
Category :
*
--Select--
Orphan
Self ESM
Serving Personnel
Widow
ZSB :
*
--Select ZSB--
Balasore (Balasore, Bhadrak, Mayurbhanj)
Cuttack (Nayagarh, Kendrapara, Jagatsinghpur, Jajapur, Cuttack, Puri, Khurdha)
Dhenkanal (Dhenkanal, Angul)
Ganjam (Ganjam, Gajapati)
Kalahandi (Kalahandi, Boudh, Kandhamal, Nuapada, Nabarangpur)
Keonjhar (Keonjhar)
Koraput (Koraput, Rayagada, Malkangiri)
Sambalpur (Sambalpur, Bolangir, Sonepur, Deogarh, Sundergarh, Jharsuguda, Bargarh)
First Name :
*
Middle Name :
Surname :
Do you have an Existing ESM Id Card ? :
Yes
No
Ex-Serviceman Id card(Enter Id card No.):
*
Service Number:
*
Service Number of ESM :
*
Type of Service :
*
--Select--
Army
Navy
Air Force
Present Unit :
Rank :
*
--Select Rank--
Date of Enrollment :
*
Aadhar Card Number :
*
Please Enter valid Aadhaar Number.
Date of Birth :
*
Date of Discharge :
Date of Death of ESM (if applicable):
Father's Name/Husband's Name :
Mobile No :
*
Mobile No. already exist...Please give different.
Email Id :
*
Email Id already exist...Please give different.
Your Email Id will be login ID
Personal Details
House No. :
Street No. & Name :
Post :
Police Station :
Village :
City :
State :
*
Odisha
District :
*
--Select--
Angul
Balasore
Bargarh
Bhadrak
Bolangir
Boudh
Cuttack
Deogarh
Dhenkanal
Gajapati
Ganjam
Jagatsinghpur
Jajpur
Jharsuguda
Kalahandi
Kandhamal
Kendrapara
Keonjhar
Khordha
Koraput
Malkangiri
Mayurbhanj
Nabarangpur
Nayagarh
Nuapada
Puri
Rayagada
Sambalpur
Subarnapur
Sundargarha
Country :
*
India
Pin Code :
*
Please Enter valid Pin Code.
Is your bank account number linked with aadhar card number ? (Tick for Yes)
Name Of Bank Account Holder :
Bank Name :
--Select--
SBI
PNB
Other
Branch Name :
Account No. :
(Kindly enter your bank account number which is linked with aadhar to ensure correct payment)
*
IFSC Code :
*
Pensioner/Non Pensioner :
*
--Select--
PENSIONER
NON PENSIONER
PPO Number :
Verification Code
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