VEDANT AYYAPPAN TRUST C-5, Flat no.602, Vedant Phase III Co –op housing Society Ltd, Vartak Nagar, Thane(W) - 400606 MEMEBRSHIP APPLICATION FORM A. 1. Identity Details Paste your photo here Name of Applicant (As appearing in your PAN Card). Father/Spouse Name 2. Gender: Male Female B. Marital status Single ` Married C. Date of Birth 3. Date of Marriage 4. Nationality: Indian Other 5. Details of Children NAME 1. DATE OF BIRTH QUALIFICATION Please enclose a duly attested copy of your PAN Card . Address Details Address for correspondence City/Town/Village State 2. MARITAL STATUS 1 6. PAN : B. GENDER (M/F) Contact Details Mobile # Tel Res Email ID Alternate Mobile # (if any) Pin code Country BLOOD GROUP C. 1. Membership Details To become a trust member you are require to pay one time Joining Membership fees of Rs.1000 and Rs. 500 there after every year towards membership renewal fee. 2. Are you willing to be a permanent member Mode of payment If cheque, please provide details of Bank/Branch: Cash Yes No Cheque Are you willing to make a monthly voluntary contribution to the trust Yes No. If yes, please note the minimum expected contribution is Rs 500. Kindly note, if needed you can also make one time contribution to trust directly. D. Other Details 1. Blood group details: 2. Are you Eligible for Blood donation 3. Previous ailments (if any) 4. What are your talents / things that might interest you. How do you propose to contribute (Your talents) to the trust Yes No Notes: 1. E. The trust may request a copy of PAN Card if needed for record purpose Other Details I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false, untrue, misleading, or misrepresenting, Vedant Ayyappan Trust or its members should not be held liable for it. DATE: PLACE: Signature of Applicant ACKNOWLEDGEMENT FORM Thank you for your support to Vedant Ayyappan Trust. We acknowledge receipt of payment vide Demand Draft/Cheque No. _________ dated ____________ drawn on ______________ Bank for Rs._____________.
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