INTERNATIONAL HUMAN RIGHTS ASSOCIATION

Access to Justice and Human Rights forAll

IHRA Govt Reg : 9620/IV 865

Application Form for IHRA Membership

To be filled by the applicant

Please read the deed of discharge, release and indemnity and guidelines before filling up the form.

Photograph of the
Candidate
with signature

Personal Information:

Name:
(Last Name First Name Middle Name)

Father’s/Mother’s/Husband’s Name:

Birth Date: Day Month Year Sex: Male Female Blood Group:

Address:

City: State: Country

Postal Code:

Telephone: Res(with std code): Mobile:

Office(with std code):
E-mail : PAN Card No :

Qualification: Profession:

Nationality:

Attached Documents’ copies:

Passport/Ration Card/Driver’s License/MSEB Bill/Telephone Bil/Election Card for address proof

No Criminal Record Certificate
PAN Card IHRA
Two passport size photographs with signature on the back of second photo
DD of Rs. 5000/- for Active Membership and DD of Rs. 10,000/- for Institutional Membership
DD should be in name /favor of International Human Rights Association Payable Pune Only.

Has the candidate previously been the member of the IHRA?

Yes No

Is the candidate a member of, or previously been a member of any other non-profit organisation?
Yes No

Has the candidate been involved with any social activities in the past?
Yes No

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Preferences of the candidate for the kind of work he/she would like to get involved in IHRA:
1.
2.

Deed of Discharge, Release and Indemnity:

1) The member agrees to abide by the rules of International Human Rights Association(IHRA) at all times.

2) Release and Discharge:

The member releases, discharges, waives and forever holds IHRA harmless from all claims or for any loss sustained by
the member whether caused by IHRA's negligent actor willful act or omission, breach of contract, breach of statutary
duty or otherwise in connection with IHRA.

3) Indemnity:
The member indemnifies IHRA against all claims for any loss sustained by the member whether caused by IHRA
negligent act or willful act or omission, breach of contract, breach of statutory duty or otherwise in connection with
IHRA.

4) Warranty as to Age:
By personally executing this deed, the candidate warrants that he/she is atleast of 18 years of age and 15 years for youth
cell.

5) Bar to Action:
The candidate agrees that this deed may be pleaded as a bar to any action, suit or proceedings taken at any time by the
candidate against IHRA arising out of or as a consequence of IHRA or any incidental activities.

6) Confidentiality:
The candidate must keep the terms of this deed strictly confidential and no disclosures of the terms of this deed is to be
made by the candidate other than for the purpose of obtaining legal advice.

7) Definitions:
In this deed unless inconsistent with the context and subject matters "All claims" means all claims, actions, suit, demands,
damages, interest, and costs arising out of or as a consequence of IHRA including any incidental activity. "Any loss"
means any loss, damage or injury to person (including candidate) or property included but not limited to any.

8) Signatures:
Signatures executed as a deed.

I______________________________________ wish to become a member of IHRA. I understand that the process requires my
application to be approved by the board of members of IHRA . do hereby give my consent that I am willing to join in International
Human Rights Association in any designation/nomination as decided by the organization with my free will, consent and without
any undue influence, coercion. I have complete and full knowledge and understandings about the workings, procedures, rules,
and regulations of the governance of the IHRA organizational activities.I shall also update myself with all the statutory and legal
compliances from time to time on the procedural workings of the organization. Expenses, membership fees, documentation fees,
advisory services, consultations, clerkage etc., if any incurred by me towards joining the organization, is made at my free will and
consent and I have no claims of any sort on the organization and its members.

[I hereby submit voluntarily at my/our own discretion, the physical copy of Aadhaar card/ physical e-Aadhaar/ masked Aadhaar /
ofline electronic Aadhaar xml as issued by UIDAI(Aadhar), to International Human Rights Association for the purposes of
verification/ establishing of my/our identity /address proof and voluntarily give my/our consent to apply for the membership in the
International Human Rights Association and hereby give my/our consent with free will and without any coercion, undue
influence to International Human Rights association for verification of my/our Aadhaar to establish its genuiness through Quick
response (QR) code embedded in the Aadhaar Card or through such other acceptable manner as per UIDAI or under any Act or
Law from time to time. The consent and purpose of collecting Aadhaar has been explained to me in local language. International
Huuman rights Association has informed me/us that my/our AAdhaar submitted to the association shall not be used for any
purpose other than mentioned above, or as per requirements of law. International Human Rights Association has informed me
that this consent and my/our Aadhaar will be stored along with my/our application details within the Association administration.]
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 “I ____________________________________, S/D/W/o ________________________, Occupation__________________
Aged____ years, R/o_______________________________________________________________________________ hereby
solemnly and sincerely affirm that the information along with the documents furnished by me in the application form is
true and correct. I have not concealed any information. However if any information furnished here in is fraudulent,
incorrect or untrue, I understand that I am liable to criminal prosecution and I also agree to forego my membership of
International Human Rights Association(IHRA). Further that the membership of IHRA is liable to be cancelled.
I have read the deed of discharge, release and indemnity and agree to abide by it”.

Place:

Date :

Signature of the Candidate Signature of the Candidate

To be filled by the Witness

Witness Name:

Address:

Phone: Profession:

I, Mr/Mrs/Miss _________________________________________ know the applicant personally for a period of years

months and confirm that to the best of my knowledge, he/she is suitable for the membership.

Place:
Date : _____________________________ Signature of the Witness

For office use only (Taluka/District/State/National Body Office of IHRA Or Any Cell of IHRA)

This is to confirm that the information given by the candidate in the application has been checked for validity and that
the documents enclosed have been verified. The candidate is found suitable for the membership of IHRA.

Signature:

1. Recommended By: ________________________________

2. _________________________________
(Member at District/Taluka/Mandal)

3. _________________________________
(Member of State/zone)

4. _________________________________
(Administration/EGC/Law Division)

NOTE: Atleast 3 Signification/s for the approval of the Application is Required/ Mandatory

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 For office use only (International Body Office of IHRA)

The candidate is found eligible for the membership of IHRA and is nominated as the ____________________________________________
at _____________________________________________________________place, ____________________________________________ country.
OR
The candidate’s application has been rejected.

Place: Mr. David Raj

Date : President
IHRA

Membership No. Allotted: __________________________________________

Guidelines For Filling The Application:

1) Fill out the application form correctly and completely. Place an X/ in appropriate box.
Use only ball pen for signature.
2) Two identical copies of passport size recently taken ID photographs with signature on the back of 2nd photo are
necessary.
3) Name and Address should be written in capital letters only.
4) Application and Related Material should be posted to the following address given below:
International Human Rights Association, Flat no. 1, Guruprasad Building, Pimple Nilakh, Aundh Camp Pune 411027.
5) To be effective as a deed, candidate’s execution of this document must be signed in the
presence of a witness who must sign in the place provided.
6) For any enquiries regarding membership issues, e-mail at members@ihra.co.in or call us 09860822253
For any other information visit the site www.ihra.co.in

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