Nagar Panchayat Pinahat, Agra

Tankers Request Form

Applicant Name *

Applicant Father Name *

Wards No *

Address Line 1 *

Address Line 2 *

City *

State *

Postal Code *

Applicant Contact No. *

Tanker Type *

Request Date *

Booking Days *

Place of Booking *

Upload Photo of Place *

Nagar Panchayat Pinahat, Agra, U.P.

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