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    Membership

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    123epc
    This document is an application form for membership in the Retired & Senior Citizens Brotherhood organization for individuals aged 60 and older. It requests basic personal information from the applicant such as name, date of birth, occupation, address, contact details, and medical conditions. It also includes spaces for an emergency contact and signatures agreeing to the organization's rules. Upon acceptance, a smart identity card will be issued with key member details.

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    Membership

    Uploaded by

    123epc
    36 views2 pages
    This document is an application form for membership in the Retired & Senior Citizens Brotherhood organization for individuals aged 60 and older. It requests basic personal information from the applicant such as name, date of birth, occupation, address, contact details, and medical conditions. It also includes spaces for an emergency contact and signatures agreeing to the organization's rules. Upon acceptance, a smart identity card will be issued with key member details.

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    This document is an application form for membership in the Retired & Senior Citizens Brotherhood organization for individuals aged 60 and older. It requests basic personal information from the applicant such as name, date of birth, occupation, address, contact details, and medical conditions. It also includes spaces for an emergency contact and signatures agreeing to the organization's rules. Upon acceptance, a smart identity card will be issued with key member details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views2 pages

    Membership

    Uploaded by

    123epc
    This document is an application form for membership in the Retired & Senior Citizens Brotherhood organization for individuals aged 60 and older. It requests basic personal information from the applicant such as name, date of birth, occupation, address, contact details, and medical conditions. It also includes spaces for an emergency contact and signatures agreeing to the organization's rules. Upon acceptance, a smart identity card will be issued with key member details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Retired & Senior Citizens Brotherhood

    (Regd)
    (An organization Of, For and By the Senior Citizens)

    APPLICATION FOR MEMBERSHIP


    (Age for Membership : 60 Years and above)

    Name (Applicant No. 1)___________________________________________________________


    Date of Birth ___________________________________________________________________
    Occupation (Business/Service) ___________________________________________________
    (If retired, Department from which retired)
    Any Major ailment (Diabetic, B.P.
    Heart Disease, Blood Group)_______________________________________________________
    Spouse name (Applicant No. 2)_____________________________________________________
    Date of Birth ____________________________________________________________________
    Any Major ailment (Diabetic, B.P.
    Heart Disease, Blood Group)_______________________________________________________
    Residential Address______________________________________________________________
    _________________________________________________Pin Code_______________________
    Phone Numbers:-
    Residence_______________________________________________________________________
    Office (if working)
    Mobile __________________________________________________________________________
    E-mail __________________________________________________________________________
    Emergency Contact detail:-
    Name/Address/Relationship________________________________________________________
    Phone/Mobile No. ________________________________________________________________

    I agree to abide by the decisions of the Retired & Senior Citizens Brotherhood (Regd.)
    and will cooperate to maintain discipline during the programmes.
    ______________________ ______________________
    (Applicant’s Signature No. 1) (Applicant’s Signature No.2)

    Date:____________

    Enclosures : Two Stamp sized latest photographs and photocopy of Aadhar Card (for self and
    spouse) alongwith Life Membership Fee of Rs.1000/- preferably by a cheque (for single/couple).

    Introduced by : Name________________________________
    Address_____________________________________________________________Signature

    ……………………………………………………………………………………………………………………………

    (FOR OFFICE USE ONLY)

    Accepted for Membership No………………………………….

    Receipt No…………………………….dated……………………….

    Cash/Cheque…….…………….Online Banking Ref…………………………………………..……dated……………….…

    Date:
    General Secretary
    OFFICE LOCATION
    B-1C/56A, Janakpuri New Delhi-110058.
    Tel.: 011-45573670
    E-mail: rscbrotherhoodnew@gmail.com
    Website: https/www.rscb.in
    ISSUE OF SMART IDENTITY CARD

    R&SCB Smart Identity Cards

    Member Spouse
    MEMBERSHIP NUMBER
    NAME
    MOBILE NO.
    DATE OF BIRTH
    BLOOD GROUP
    ARE YOU DIABETIC
    In case of Emergency, Name,
    address, relationship of the person
    to be contacted in case of
    emergency (with Tel./Mobile No.)

    Member’s Photo Member’s Signature

    Spouse Signature
    Spouse Photo

    rscb/gkk/2022/4

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