नया सदस्य्ता आवेदन फार्म
नया सदस्य बनने हेतु नीचे का विवरण सही से भरें!
1. PERSONAL DETAILS
NAME
FATHER'S NAME
MOTHER'S NAME
DATE OF BIRTH
AGE
CASTE
SELECT CASTE
BADHAI
LOHAR
KASHERA/THATHERA
SHILPKAR
SONAR
EDUCATION
2. ADDRESS & CONTACT DETAILS
FULL ADDRESS (HOUSE NO/STREET)
VILLAGE/TOWN
PANCHYAT/WARD NO.
POST OFFICE
POLICE STATION (THANA)
BLOCK
DISTRICT
SELECT DISTRICT
ARARIA
ARWAL
AURANGABAD
BANKA
BEGUSARAI
BHAGALPUR
BHOJPUR
BUXAR
DARBHANGA
EAST CHAMPARAN
GAYA
GOPALGANJ
JAMUI
JEHANABAD
KAIMUR
KATIHAR
KHAGARIA
KISHANGANJ
LAKHISARAI
MADHEPURA
MADHUBANI
MUNGER
MUZAFFARPUR
NALANDA
NAWADA
PATNA
PURNIA
ROHTAS
SAHARSA
SAMASTIPUR
SARAN
SHEIKHPURA
SHEOHAR
SITAMARHI
SIWAN
SUPAUL
VAISHALI
WEST CHAMPARAN
STATE
PIN CODE
MOBILE NUMBER
ALTERNATE MOBILE
EMAIL ID (OPTIONAL)
3. REFERRAL & AUTHORITY DETAILS
JILA SACHIV/ADHYAKSH NAME (OPTIONAL)
REFERRAL NAME
REFERRAL MOBILE NUMBER
OCCUPATION
JOB PLACE
AADHAR NUMBER
4. MEMBERSHIP & PAYMENT
SELECT MEMBERSHIP DURATION
SELECT YEAR
1 YEAR (₹ 120)
2 YEARS (₹ 220)
3 YEARS (₹ 330)
4 YEARS (₹ 440)
5 YEARS (₹ 500)
TOTAL PAYABLE AMOUNT
5. DOCUMENTS UPLOAD
PHOTO
AADHAR FRONT
AADHAR BACK
SUBMIT & PROCEED TO PAYMENT
