Artist Name(Full name in Block letters)  
  Father Name(In Block letters)
  Date of Birth (DD/MM/YYYY)  
  Gender (Male/ Female)  
  Languages Known  
  Address – 1 (present)  
  Address – 2 (permanent)  
  State
  District  
  Pin Code  
  Mobile No. of the artist  
  Name of Art Form/ Cultural Practice  
  Category  
  Sub Category
  Sub - Sub Category  
  Sub - Sub - Sub Category  
  Others (Type Here)  
  Art Form (Endangered/ Practicing/ Surviving)  
  If Practicing (Method of learning)  
  Experience in Art Form
  Name of the Organisation/ individuals associated  
  Complete Address of the organization/ individuals associate  
  Telephone No. of the artist  
  Email-id of the artist  
  Aadhar No. of the artist  
  Name of the Bank and Bank Acct. No. of the artist
  IFSC code. of Bank (for artist)  
  Aadhar linked Bank Account No. of the organisation  
  Bank Name (for Organisation)  
  Branch Name & IFSC code (for Organisation)  
  Have you enrolled for any schemes
of Central/ state Govt. (Yes/ No)
 
  If yes as above Scheme under which enrolled
  Submitted By