Junior Cube Association

First Name *

Middle Name

Last Name *

Date of Birth *

Gender *

Male Female Other

Contact Number *

Whatsapp Number *

Email *

Address * (Prizes get delivered here)

Landmark

City *

State *

Country *

Pincode *

Upload Profile Picture

Note: (Maximum size 1 MB) Don't upload files directly from Google drive

Upload ID Proof * (Adhar Card)

Note: (Maximum size 1 MB) Don't upload files directly from Google drive

PAN Number *

Bank Name *

Account Name *

Account Number *

IFSC Code *

If the bank details are someone else then please upload the Adhar Card of that person

Note: (Maximum size 1 MB) Don't upload files directly from Google drive

Email Verification Code *

The verification code has been sent to the given email address.