Transcript of "Seo2 india-devang barot - Indian Youth Congress Membership From"
DO NOT CHANGE SIZE
WHILE COPYING OR
PRINTING THIS FORM
Instructions : PHOTO
1) Form should be preferably filled in English and in BLOCK CAPITAL
2) Attach photocopy of approved Address proof, Photo ID proof & Age proof Barcode
3) Remit Membership fee of Rs 15 or Rs 5 for Women and SC/ST (attach Paste recent
photocopy of caste certificate). An additional surcharge of Rs 5 may original
apply during the last 3 days of membership drives. photograph.
Do not staple.
State : Lok Sabha :
Assembly : Panchayat/ Ward :
First Name Last Name
Full Name :
Father/Husband’s Name :
Strike out whichever is not applicable
D D M M Y Y Y Y
Date of birth : Sex : M F Blood group :
Present Address :
City/District : Pincode :
Landline : Mobile :
* Separate the STD code and number with a dash
Category : General SC ST OBC Minority
Declaration : I wish to apply for the annual membership of the Indian Youth Congress. I accept the constitution of
the Indian Youth Congress and I declare that -
- The information given by me in this form and enclosures is true.
- I am under 35 years of age and a Citizen of India.
- I am not a member of any other political Party.
- I have never been convicted of any criminal Signature /
offences by any court
Thumb impression :
Date : * Ensure signature / thumb impression is within the box
Acceptance of the membership form does not guarantee enrollment as a member of the Indian Youth Congress The membership fee paid along with the form is non-refundable under any circumstance
Office Assembly code : Age Proof verified: Age Proof code : Date :
use Panchayat /Ward Address Proof verified: Address Proof code :
only : code :
Received Rs. ________ LRO name : ___________________________ LRO signature :
Receipt INDIAN YOUTH CONGRESS Barcode
You must produce this #5 Raisina Road, New Delhi - 110001.
receipt during voting Ensure that barcode
sticker is pasted on the
Name : receipt.
Father / Husband Name :
(Strike out whichever is not applicable)
Received Rs.________ Assembly code : Panchayat / Pincode :
*To be filled by LRO Ward code :
towards subscription *To be filled by LRO
Date : LRO name : LRO signature :
Reach us: Web : www.iyc.in Email : email@example.com Helpdesk : 1860-425-4357 (Monday to Saturday, 10AM to 5PM) Acceptance of this form does not
Find out more at www.iyc.in
guarantee enrollment into the IYC
The IYC is Transforming ! The membership fee is
non-refundable under any
Open Internal Code Professional Nationwide Performance circumstance
Membership Elections of Conduct Training Programs Management