|| श्री नाकोड़ा पार्श्वनाथाय नमः ||

SHRI SIWANCHI JAIN YUVA MANDAL

# 13 2nd Floor, No. 204, Paxal Tower, K.R. Road (Fort), Bangalore 560 002.

Email: ssjymblr2017@gmail.com

APPLICATION FORM

Working Committee - Shri Siwanchi Jain Yuva Mandal, Bangalore

To,
The Working Committee,
Shri Siwanchi Jain Yuva Mandal,
Bangalore

Dear Sir,
I wish to become a life time member of Shri Siwanchi Jain Yuva Mandal. Please enroll me as a member. I will make sure that I shall abide to all the rules and regulations of Mandal.

Personal Information

Member Name *

Surname *

Father Name *

Gotra

Blood Group

Age *

Date of Birth *

Phone Number *

password *

Marital Status

Yes

Professional Information

Office Address

Type of Business

Profession

Contact Information

Residence Address

Mobile Number

Phone Number

WhatsApp Number

Email Address

Additional Information

Native Place

Hobbies (Interests in)

Proposal Member Name

In Rajasthan

Upload Documents

Profile Photo *

Click to upload

PNG, JPG, JPEG up to 5MB

Applicant Signature *

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PNG, JPG, JPEG up to 5MB

Important Notes:

Lifetime Membership fee is Rs. 500/- only (Rupees Five Hundred Only)
One can become life member from age 18 to 40 years only
Retirement age of a member will be 45 years
Date of Birth & Address Proof to be provided with this form
Attendance in each activity is compulsory