Intechronix Registration Portal

Secure multi‑step registration • PAN/Aadhaar + uploads • PIN auto‑fill

Step 1 of 7
Basic details

Basic Details

Enter your personal information to begin registration.

Please enter your full name.
Please enter a valid email address.
Enter a valid 10-digit Indian mobile number.
Example: 9876543210
Please select your date of birth.

Profile Picture Upload

Upload a clear passport‑style photo (JPG/PNG/WebP).

Please upload an image (max 2 MB).
Accepted: JPG/PNG/WebP. Max 2 MB.
Profile preview No image
selected
No file selected

Address (PIN Auto‑Fill)

Enter PIN code to automatically fetch State / District / Post Office.

Enter a valid 6-digit PIN code.
Tip: Enter PIN (e.g., 273007). It will auto-fill State/City and Post Office list.
Please enter your address line.
State is required (auto-filled from PIN or select manually).
City/District is required (auto-filled from PIN or enter manually).
Please select a Post Office (after PIN lookup).
Post office list loads automatically after PIN lookup.

Education Details

Provide your highest education details.

Please select your highest qualification.
Please enter institution name.
Please enter passing year.
Optional

KYC (PAN & Aadhaar) + Uploads

PAN + Aadhaar numbers and uploads are merged into one tab. PAN Back is optional.

Enter a valid PAN (e.g., ABCDE1234F).
Enter a valid 12-digit Aadhaar number.
Upload PAN front (image/PDF, max 5 MB).
Optional. Upload only if available.
Upload Aadhaar front (image/PDF, max 5 MB).
Upload Aadhaar back (image/PDF, max 5 MB).
No KYC documents selected
Max size: 5 MB each (change in code if needed).
Supporting PDF
Upload any supporting document (PDF only).
Please upload a PDF file (max 5 MB).
Accepted: PDF only. Max 5 MB.
No PDF selected
Aadhaar OTP via UIDAI requires an authorized integration (AUA/KUA). This demo provides an optional placeholder only.

Medical Claims Form

Fill claim details (if applicable).

Please select claim type.
Enter a valid amount (minimum 1).
Please enter hospital/clinic name.
Please select treatment date.
Optional

Terms, Review & Submit

Confirm details and submit.

Email sending: Use EmailJS (frontend, free tier) or Brevo/SMTP (backend). Aadhaar OTP is optional placeholder.
You must accept the terms to submit.
✅ Submitted locally (demo). Check console for payload.