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Railway Mall Godam Membership Form

This document is an application form for a profile and identity card for members of the Bhartiya Railway Mall Godam Shramik Sangh. It requires personal information, educational qualifications, and a declaration from an introducer who verifies the applicant's details. The form also includes sections for signatures and a declaration of responsibility regarding the accuracy of the provided information.

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ajeet shilpkar
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524 views1 page

Railway Mall Godam Membership Form

This document is an application form for a profile and identity card for members of the Bhartiya Railway Mall Godam Shramik Sangh. It requires personal information, educational qualifications, and a declaration from an introducer who verifies the applicant's details. The form also includes sections for signatures and a declaration of responsibility regarding the accuracy of the provided information.

Uploaded by

ajeet shilpkar
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICATION FORM FOR PROFILE & IDENTITY CARD

FORM NO.:
IF PROFILE ID IS NOT AVAILABLE THEN SELECT/GIVE APPROPRIATE CAUSE Please affix
1. Already applied: 2. Not applied: 3. New applied: 4. Others: Passport Size
ZONE: ……………………………………………………………………… Division: …………………………………………. Recent

Membership Date: ………………………………………………….. Shed: ……………………………………………… Photograph

Name: …………………………………………………………………….. Designation: …..……………………..……………………………………..


F/H Name: ………………………………………………………………. Correspondence Address: .……………………………………………
D.O.B: ……………………………… Sex: …………………………… ………………………………………………………………………………………
Blood Group:……………… Married Un-Married Permanent Address: ……………………………………………………..
Category: ………………………..……………..(UR/SC/ST/OBC) ………………………………………….Dist: …………………………………..
Mobile No: ………………………..…………………………………….. State: …………………………………………..Pin: …………………………
Aadhaar No.: Email Id: ..………………………………………………………………………
Bank Name: ……………………………………………………………… Branch Name: ……………………………………………………………….
A/C No.: …………………………………………………………………… IFSC Code: ……………………………………. Type: ………………….

SL NO. Examination Passed Name The of Institution/University Subject Year of Passing % of Marks

1 10TH

2 12TH

3 Graduation

4 Others / 8TH
Education Qualification:
Name of Introducer:_________________
Contact Number: ___________________
Introducer Signature:________________
Form Submission Date_______________
Left Thumb Impression Signature

______________________________________________________________________________________________________
Declaration of Introducer:
I am ________________________________Son of / Daughter_______________________________ of residing at as a member
of Bhartiya Railway Mall Godam Shramik Sangh is hereby declare that , this membership application form collected by me along with
the applicants documents and union membership fees . I declared that the details of the applicant is verified by me and true as per my
knowledge. I collect this membership application form following the bylaws of Bhartiya Railway Mall Godam Shramik Sangh . I assure
that I will submit this application form along with the documents and membership fees to my immediate signatory leader within 3 days.
I also declared that , at any time if any complaint raised regarding fraud documents or information about the membership or any
complaint regarding collection of membership fees out of union bylaws or any complaint about the past criminal record of the applicant
I will be responsible for that .

Declarant Signature Authorized Seal & Signature

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