Customer Registration Form

Title*

First Name*

Last Name*

Gender*

Date of Birth*

Mobile No.*

Email-ID*

Confirm Email-ID*

Travellers Type : Belongs to

Office-Id Number / Employee Number*

Category*

Password*

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Declaration*

Self-declaration during registration - I am aware that this website is for the government of India employees and I being am a government of India employee doing registration to avail all the services and benefits provided. I hereby declare that the information given is correct. I am well aware of the fact that if the information given by me is proved false/not true, then Balmer Lawrie has the right to cancel my journey services without any refunds and block/deactivate my services permanently, and may also lead to necessary proceedings. Also, all the benefits availed by me shall be summarily withdrawn.

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