New Registration        (All fields marked with * are mandatory)

User ID*
 

Occupier First Name*

Occupier Last Name*

Date of birth*

X
Sun Mon Tue Wed Thu Fri Sat

Mobile*
(+91)

Land Line No

 

Email*

Factory Name / Boiler Owner Name *
Factory Address / Boiler Owner Address*
City*
Pincode*

captcha*
 
 
 

Note:

  1. User ID should not contain special characters (~ ! @ # $ % ^ & *) except underscore and dot( _ . )

  2. Mention only 10 digit mobile number and enter only numbers (no hyphens or +)

  3. In case of Land line phone number first mention area code then mention phone number.

  4. Date of birth should be in (DD/MM/YYYY) format.

  5. If you are unable to register with your company email id, please send a mail to helpdesk.surakshate@karnataka.gov.in with your details.