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    WHRC APPLICATION FORM new

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    icondigitalssdnr
    WHRC APPLICATION FORM new

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    WHRC APPLICATION FORM new

    Uploaded by

    icondigitalssdnr
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    WHRC APPLICATION FORM new

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    WHRC APPLICATION FORM new

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1 views3 pages

    WHRC APPLICATION FORM new

    Uploaded by

    icondigitalssdnr
    WHRC APPLICATION FORM new

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    WORLD HUMAN RIGHTS COUNCIL

    Access to Justice and Human Rights for All


    Promoting Training Education And Research on Human Rights

    APPLICATION FORM FOR MEMBERSHIP


    To be filled by the applicant

    Please read the deed of dicharge, release and indemnity and guidelines before filling up the form Photograph of the
    Candidate
    with signature

    Personal Information:

    Name :
    ( First Name ) ( Middle Name ) ( Last Name )

    Father’s/Mother’s/Husband’s Name :

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

    Address :
    City Mandal_______________________District___________________ State _____________________

    Country __________________________________________ Postal Code

    Telephone : Res (with std code ) : Mobile :


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

    Qualification : Profession :

    Nationality : ________________________Religion ;__________________________ Caste ; ____________________________

    Attached Documents’ copies :

    Passport / Ration Card / Driver’s License / MSEB Bill / Telephone Bill / Election Card for address proof
    No Criminal Record Certificate
    PAN Card
    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 World Human Rights Council.

    Has the candidate previously been the member of the WHRC


    Yes No If Yes, Submit details

    Has the candidate a member of, or previously been a member of any other non-profit organization?
    Yes No If Yes, Submit details

    Has the candidate a been involved with any social activities in the past ?
    Yes No If Yes, Submit details

    Preferences of the candidate for the kind of work he/she would like to get involved in WHRC :
    1.
    2.
    Deed of Discharge, Release and Indemnity:
    1) The member agrees to abide by the rules of World Human Rights Council (WHRC) at all times
    2) Release and Discharge :
    The member releases, discharges, waives and forever holds WHRC charmless from all claims for any loss sustained by
    the member whether caused by WHRC negligent actor willful act or omission, breach of contract, breach of statutory duty
    or otherwise in connection with WHRC.
    3) Indemnity :
    The member indemnifies WHRC against all claims for any loss sustained by the member whether caused by WHRC
    negligent act or willful act or omission, breach of contract, breach of statutary duty or otherwise in connection with WHRC.
    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 WHRC arising out of or as a consequence of WHRC 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 WHRC 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 WHRC. I understand that the


    process requires my application to be approved by the board of members of WHRC.‘‘I hearby 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 World Human Rights
    Council (WHRC). Further that the membership of WHRC 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

    To be filled by the Witness

    Name_______________________________________________________________________________________________________

    Address_______________________________ Phone : ________________________ Profession_____________________________

    1, 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

    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 WHRC.

    Signature....................................... Signature...................................... Signature..................................................

    Mandal Chairman State Chairman National Committee Chairman


    Place Place Place
    Date Date Date

    For office use only (International Body Office of WHRC)

    The candidate is found eligible for the membership of WHRC and is nominated as the _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
    at………………………………… place………………………………… country………………………………………….

    OR

    The candidate’s application has been rejected.

    Place : Mr. R Bala Raju


    Date : National Chairman
    WHRC

    Membership No. Allotted Code

    Guide lines 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 :
    World Human Rights Council, Flat No.1, Guruprasad Building, Pimple Nilakh, Anudh 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@whrc.co.in or call us 0959336440
    For any other information visit the site www.whrc.co.in

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