Dist-Level Member - Sukanya Surakshya Charitable Trust

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Personal Details

Full Name

Father's Name

Date of Birth

Aadhar Number

Mobile Number

Alternate Mobile

Email Address

Full Address

District

State

Gram Panchayat

Panchayat

Block

PIN Code

Full Address

Bank Details

Bank Name

IFSC Code

Account Number

Documents Attached

☐ Passport-size photographs
☐ Aadhar Card photocopy
☐ Bank Passbook photocopy
☐ PAN Card photocopy

Payment Details (Scan to Pay)

Acc No 50200119721619

IFSC Code HDFC0005335

After filling the form, please make the payment by scanning the above QR code or through the bank account.

Declaration: I hereby declare that all the information provided in this form is true and correct to the best of my knowledge. I understand that providing false information may result in the rejection of my application.

Applicant's Signature

Date

Father/Mother's Signature

Sukanya Surakshya Charitable Trust | Regd: OD55930394445581Y | www.sukanyasurakshya.org

Sukanya Surakshya Charitable Trust

Dist-Level Member — Application Form