First Name                                                   Enter fname

Middle Name                                              

Last Name                                                 

Date of Birth                                               

Age                                                            Enter age
               
Blood Group                                              Blood Group O+ O- B+ B- A+ A- AB+ AB-   bloodgroup

Spouse                                                    

Status                                                     Status Student Working Homemaker Retired Infant Select status

House                                                     House

Address                                                  Enter address

Current City                                           Enter city

Current Country                                    Enter country

Username                                             username

Contact Number                                   contactnumber

Password                                             Enter password

Retype Password                                 Password and retype not matching
 
Secret code                                              Enter secretcode