Chikitsa Sandbox Request Form
Entity Name
Type of organization
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Are you registered/licensed to operate in India?
Yes
No
Enter GSTIN
Product name
Website (include https:// or http://)
Registered Address
Pincode
State
Eg. Rajasthan
District
Eg. Jaipur
ADMIN INFO
Full Name
Email ID
Mobile number
Set password (will be used to login)
I agree to the terms and conditions stated in the Chikitsa Sandbox guidelines*
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