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   Member Registration

 
MEMBERSHIP / ID APPLICATION
(PlEASE FILL IN CAPITAL LETTER)


E.mail : info@againstcorruptionhrp.com ,                              M : +91 9969049114                               www.againstcorruptionhrp.com
 
 
 
  NAME* :   OCCUPATION :
  NAME OF FATHER'S * :   NAME OF MOTHER'S :
  MOBILE N0. :   TEL. NO. (R) :
  DATE OF BIRTH :
 ( DD-MM-YYYY )
  AGE :
  SEX :   BLOOD GROUP :
  STATE :   NATIONALITY :
  PAN / GIR NO. :   UPLOAD PHOTO :
  PRESENT ADDRESS* :
  POST* :   DIST. :
  STATE :   PIN CODE * :
  PERMANENT ADDRESS* :
  POST* :   DIST. :
  STATE :   PIN CODE * :
  E-MAILl_ID* :
  ( DD / MONEY TRANSFER , IN FAVOUR OF : -AGAINST CORRUPTION HUMAN RIGHTS PROTECTION (REGD.).
BANK :- BANK OF INDIA,    A / C NO. :- 000320110001010,    IFSC CODE :- BKID0000003 ),   BRANCH :- BALLARD ESTATE, MUMBAI - 38
 

Payment Details                                  MODE :

               
   DD NO :   AMOUNT :
  BANK NAME :   BRANCH NAME :
               
 

Terms and conditions: *

 

I hereby declare that the particulars given above are true to the best of my knowledge and belief. I will abide by the rules & regulation of " Against Corruption Human Rights Protection (Regd) India" and will serve the humanity to the best of my ability without any profit motive. I will be solvay responsible for any acts done by me against the rules & regulations of " Against Corruption Human Rights Protection (Regd) India" . I will conduct myself with the highest ethics and integrity. I represent that I have been convicted of felony of charged with crime involving immoral acts or dishonestly " Against Corruption Human Rights Protection (Regd) India" reserve all rights to accept, rejecter or resolve any new application / renewals. I hereby unconditionally agree to publish my name with or without photograph in the mass media. This membership shall be governed by the laws of India and courts of New Delhi. India shall have exclusive jurisdiction over any disputes arising from this membership. *

 

Details of Documents Being Produces ( Please Attach Xerox Copy Identity Proof & Address Proof ) *

 

    Membership Fee Rs. 1000 /- ( By DD infavour of " Against Corruption Human Rights Protection (Regd) India" )