Membership Application Form
Title*
Mr.
Mrs.
Ms.
Name*
Category*
Ahluwalia
Bhandari
Billava
Byahut
Deevaru
Ediga
Ezhava
Goud
Jaiswal
Jayaswal
Kalal
Kalwar
Nadar
Namadari
Poojari
Shinde
Thiyya
Blood
A+
A-
B+
B-
O+
O-
AB+
AB-
DOB
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
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66
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68
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71
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73
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81
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83
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87
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89
90
91
92
93
94
95
96
97
98
99
100
ID No.
Parents' Names
Adhaar No.
Community Contact Person
Community Contact Person Phone No.
Profession
Advocate
Agriculturist
Artist
Business
Chartered Accountant
Clown
Doctor
Educationist
Employed
Engineer
Government Official
Housewife
Industrialist
IT / BT
Journalist
Land Developer / Builder
Lunchroom supervisor
Others
Photographer
Politician
Professor
Real Estate
Religious
RTI Activist
Scientist
Social Worker
Sports
Student
Professional Details
Organisation
Address*
Booth No.
Panchayat / Ward
Taluk / Zone
District*
City*
State*
Pin*
L Sabha MP
LS Code
V Sabha MP
VS Code
Mobile1*
Mobile2
Phone1
Phone2
Email1*
Email2
Website
Remark
Photo*
Community Document
APPLY NOW
Note:
Community Contact Person Refers To the Person Of Your Community With Whom You Are In Contact.
Community Document Refers To Any Proof Of Caste.
Organisation refers to the company/place where you are currently working.
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