1. Membership Application Form
Blue Moon Charitable Trust
Regn.No:360/2008, IncomeTax Regn No: 27/12ACIT/CLT/12A/828/2009-10, 80G (5) & (VI)/3/CIT/CLT/2009-10.
Door No: XVI/318, Vanadurga Temple, P.O.Thootha, Perinthalmanna, Malappuram Dt, Kerala state, 679357
Branch (i) Kottayi Road Kallur, Thrissur, 680317,
Branch (ii) Delhi 110091. Mob:+919895293963, +919605817842, +918802460733,
Email:bluemoontrust1@gmail.com, Web:www.facebook.com/bluemoontrust1.
PLEASE FILL UP THE APPLICATION IN CAPITAL LETTER IN OWN HANDWRITING. (Except Signature in
CAPITAL LETTER)
S.No:……………Introduced By:………………………………
1. Name of the Candidate:-
S
FIRST NAME:
MIDDLE NAME:
SURNAME:
2. FATHER’S NAME:
3. MOTHER’S NAME:
4. a) CATEGORY (TICK √ ) General SC ST OBC
5) GENDER: MALE FEMALE
6) DATE OF BIRTH (DD/MM/YYYY)
7) PERMANENT ADDRESS:
House No: ___________
Street No: ___________
Area Name:__________
District:_____________
State:__________________PinCode:------------------------------
PAN:……………………Voter ID.No:……………………….. Aadhar No:…………………….

2. 8) LANGUAGE KNOWN: (PLEASE TICK √ )
SL NO LANGUAGE WRITING READING SPEAKING
1.
2.
3.
9) MOBILE NUMBER:………………………………….
10) E MAIL ID:……………………………………………
11) EDUCATIONAL QUALIFICATIONS……………………………………………..
12) PROFESSIONAL EXPERIENCE:-
Declaration
I hereby declare that to obey the rules and regulations of M/s Blue Moon Charitable Trust
and all the statements made by me in the application form and information sheet are true
and complete to the best of my knowledge and belief and nothing has been concealed or
suppressed. I also understand that in case, any of my statements is found untrue during
any stage of recruitment and thereafter, I shall be disqualified for the post applied for and I
shall be liable for any penal action.
Copy of the ID proof attached herewith.
Date:
Signature of the Candidate
Place:
I verified and approved by,
Name, Signature & Date of the zonal officer.