Form for submission of details by Specially Abled Advocates for extension of accessibility facilities at Prayagraj & Lucknow

Select Location:

Prayagraj

Lucknow

Enter Advocate Roll number

Select disability type Locomotor Visibility Hearing Select disability type

Name

Select gender Male Female Transgender Gender

Relation

Father/Husband Name

address Line1

chamber Details

Mobile Number

Email ID

Enrollment Number

Upload disability certificate (PDF only)

Enter Captcha as shown in image below

refresh volume_up

Loading..

An OTP has been sent to the Mobile Number as registered in your Advocate Roll data. Please enter the same in box below

Submit