Customer Entry
Name
{qsRes.ema.name[]}
Phone
{qsRes.ema.phone[]}
Email
{qsRes.ema.email[]}
Date Of Birth
{qsRes.ema.dob[]}
Aadhar
{qsRes.ema.aadhar[]}
City
{qsRes.ema.city[]}
App Number
{qsRes.ema.appNumber[]}
Form Name
{qsRes.ema.formName[]}
Challan Pay Here
Yes
No
{qsRes.ema.challanPay[]}
Challan Amount
{qsRes.ema.challanAmt[]}
Challan Charge
{qsRes.ema.challanCharge[]}
Challan Pay By
Self AC
None
{qsRes.ema.challanPayBy[]}
Service Charge
{qsRes.ema.serviceCharge[]}
Payment Method
Online
Cash
{qsRes.ema.paymentMethod[]}
Total: 0 (Tax - 0%)
{qsRes.d.count}
{qsRes.e.message}
Submit
Reset
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