Apply Licence

    * marked fields are compulsory

    Register

    Athlete Name *
    Father Name *
    Licence Fees: Rs.
    Mode of Payment
    Fees Receipt Reference No.
    Date of Payment
    Payment Receipt *
    Fees Receipt Reference No.

    Personal

    Your Photo *
    Date of Birth *
    Gender
    Mother Name
    Marital
    Phone No.
    Alt Phone No.
    Address Permanent
    Postal Pincode
    Address Communication
    Postal Pincode
    Email
    ID Card #/ Aadhar/ Voter ID/ DL *
    Identity Card Upload *
    Education
    Occupation
    Employer
    Office Address
    Passport No.
    Passport Expiry Date
    Passport Place of Issue

    Status

    Physical
    Disability Certificate *
    Blood Group
    Height in Cms.
    Weight in Kgs.
    Wheelchair?

    Bank

    Bank Account Number
    Bank A/c. Holder Name
    Bank Name
    Bank Branch
    Bank IFSC
    Bank IFSC

    Sport

    Para Sports :
    AthleticsSwimmingShootingPower lifting
    ParaSports +
    ArcheryBadmintonBasketball (WC)BocciaFootballFencingGoalballJudoRacing (WC)Para-cyclingPara-TriathlonRugbySitting VolleyballTable TennisTennis (WC)
    IPC SDMS Licence No.
    IPC Licence Card
    School Name
    First / Personal Coach
    National Coach
    National Certificate / Accreditation
    Athletics Track Class
    Athletics Track Status
    Athletics Field Class
    Athletics Field Status
    Swimming Class
    Swimming Class Status
    Classifier Name
    Classifier Designation
    Classified @ Place & Country
    Classification Date
    Classifier Remarks

    Achievements

    State Level: #. Performance, Event, Place, Year
    National Level: #. Performance, Event, Place, Year
    International: #. Performance, Event, Place, Year
    Achievements: Awards, Place & Year

    Undertaking

    Undertaking *