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Blood Bank Registration Form
Blood Bank Details
Blood Bank Name
License Number
License Validity (Till)
Registered Address
Street
City
State
Pincode
Representative Information
Full Name
Designation/Role
Official Email Address
Phone Number
Alternate Contact Number
Operational Details
Affiliated Hospital/Organization (if any)
Blood Bank Type:
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Government
Private
NGO/Charitable
Services Provided:
Blood Donation Collection
Blood Component Separation
Emergency Blood Supply
Blood Storage
Mobile Blood Camps
Document Uploads (PDF only)
Valid Blood Bank License
ID Proof of Representative
Authorization Letter from Blood Bank
Recent Blood Camp Report or Activity (optional)
Account Credentials
Create Username
Create Password
Confirm Password
I certify that I am an authorized representative of the blood bank.
I agree to follow all national and regional guidelines on blood donation.
I accept the Terms & Conditions and Privacy Policy.
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