KEMPEGOWDA AWARD 2022

ಕೆಂಪೇಗೌಡ ಪ್ರಶಸ್ತಿ ಅರ್ಜಿ-2022

* Indicates mandatory fields.

Note:



1. Applicant Photo should be in 'JPEG/JPG/PNG' format(Size limit 10MB).

2. Achivement Documents should be in 'PDF' format(Size limit 100MB/20 to 50 pages).


Enter Achiever Name
*

Enter Date of Birth
*
Enter Age
 *


Upload passport size Photo.
 *
Select Gender *


Enter E-Mail ID


Select MLA Constituency
*
Select Ward
*
Enter Mobile Number
 *


Enter Aadhar Number
*


Enter Postal/Present Address
*


Enter Permanent Address
*


-
Select Field
*
Brief your Achivements in specified field *


Enter Reference Name

Enter Reference Mobile Number


Award details. Upload Documents
1. Upload Aadhar Card *

2.Upload Achivement Related Documents *

Referer Document 1
Referer Document2
Referer Document 3
Declaration

    I    here by declare that the above mentioned details are true to the best of my knowledge and belief, any wrong information mentioned will lead to disqualification of my aApplication and subsequent action may be taken as per the LAW.