Munazzan Number	PTO Name
Application No. as per Ministry (Eg: DL013****23)	User ID
Password	Confirm Password
Phone Number	Email ID
Qouta Alloted	Address line 1 (India)
Address line 2 (India)	State Select State ASSAM ANDHRA PRADESH ANDAMAN & NICOBAR BIHAR CHANDIGARH CHHATTISGARH DAMAN & DIU DADRA & NAGAR HAVELI DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR ODISHA PUDUCHERRY PUNJAB RAJASTHAN TRIPURA UTTARAKHAND UTTAR PRADESH WEST BENGAL TAMIL NADU MEGHALAYA MIZORAM NAGALAND ARUNACHAL PRADESH SIKKIM OTHER STATE TELANGANA LADAKH
Date of Arrival in KSA	KSA Mobile Number