Mission Bhagiratha

Name of the Institution/Firm*

GST Number

Email

Instituion/Firm Sub Type*

Instituion/Firm Type*

Government

Private

Quality of Water*

Raw

Treated

Purpose of Request*

Address and Location of Supply

Tentative Size of the Connection (In Inches)*

Required Quantity of Water (In KLD)*

Category

District*

Constituency*

Mandal*

Panchayat*

Habitation*

Landmark*

Name of the Contact Person*

Email*

Address for Communication*

Mobile Number*

Designation*

Name of the Authorized Person*

Aadhar

GST

PAN

Others

Ownership Document

Self Decleration

Address Proof document Download Sample Self Declaration Form

Institution/Firm Details