Applicant's First Name: *	Middle Name: Last Name:
	Applicant's first name is mandatory Only alphabets are allowed in First name(Space not allowed) Only alphabets are allowed in Middle Name(Space not allowed) Only alphabets are allowed in Last Name(Space not allowed)
Establishment's Name: *		Establishment's Name is mandatory Special characters not allowed
Email: *		Email is mandatory Please provide Valid E-mail
	(All communication from CERR will be sent to this email address.)
Login Id: *	Login Id is mandatory
	(Login ID you enter, lets you sign in to Clinical Establishment Application.)
Id Proof: *	Select Driving License Others PAN Card Passport Ration Card Voter I-Card	Id proof is mandatory
Verification Code: *		Verification Code is mandatory Invalid verification code
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* Mandatory fields