Regd. :
63288 / 2008
BHARTIYA LOKTANTRIK JAN KALYAN SANSTHA
( Membership Form )
Office: Rohini Sector-22, House No. 7-8, Pocket-17, New Delhi 110086
website : www.bljks.org | E-mail ID : manoj_creativesence@yahoo.in | M. 9217239292
1. Applicant Details
Applicant Name
Father's / Husband's Name
Date of Birth
Gender
Male
Female
Other
Email ID
Mobile No.
PROFILE PHOTO
Upload a clear passport-size photo
Aadhar Number
Password
2. Permanent Address
House No.
Street / Locality
City
Pin Code
3. Type of Membership
Ordinary Member
Executive Member
Lifetime Member
Patron
4. Purpose & Joining the Organization
5. Bank Details
Account Holder Name
Bank Name
Account Number
IFSC
Account Type
6. Nominee Details
Nominee Name
Relation with applicant
Date of Birth of Nominee
7. Declaration
I hereby declare that all the information provided by me is true and correct to the best of my knowledge. I agree to follow the rules and regulation of the organization.
Date
Place :
I Acknowledge :
INTRODUCER ID :
Submit