* Login:  (min 5 characters; only a-z, 0-9 , '_' allowed)
* Password: (min 6 characters;no space;no quotes;should be alphanumeric)
* Retype:
* Name:
 Address:

 City:
 State:
 Pin:
 Phone (Res):
 Phone (Off):
 Mobile:
* Email:
* DOB:
 PAN:
 PAN: