Senior Citizen Registration Portal

Senior Citizen Registration Form

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Please provide your basic information

Full Name *

Date of Birth *

You must be at least 70 years old to register

Gender *

Male

Female

Other

Mobile Number *

This will be used to contact you

Email Address (Optional)

Landline Number (Optional)

Residential Address *

Sub Divisions *

Police Station

Aadhaar Number (Optional)

For identity verification only

Information about your work and family (optional fields)

Select your current working status

Full-Time Working

Part-Time Working

Retired

Year of Retirement

Field of Specialization

Retired From

Spouse Name

Spouse Date of Birth

Wedding Date

Number of Children

Family Type

Residing With *

Alone

Only With Spouse

Alone During Day Time