Membership Application Form | Jibantala Nabajagaran

Membership Application

Join us in serving humanity • Humanity Over Anything

Membership Fee is Rs 200/-

Personal Details

Full Name *

Please enter your full name.

Father's Name *

Please enter your father's name.

Mother's Name *

Please enter your mother's name.

Gender *

Please select your gender.

Date of Birth *

Please enter a valid date of birth.

Blood Group

Please choose your blood group.

Identification & Contact Details

Aadhaar Number *

Please enter a valid 12-digit Aadhaar Card number.

Mobile Number *

Please enter a valid 10-digit primary mobile number.

Email Address *

Please enter a valid email address.

Highest Qualification *

Please input your highest educational criteria.

Occupation *

Please enter your occupation details.

Communication Address

Village / Street / Para *

Please input village or street address.

Post Office *

Please specify the post office name.

Police Station *

Please input the local police station name.

District *

Please enter your district name.

State *

Please enter your state name.

PIN Code *

Please enter a valid 6-digit postal index number.

Upload Documents (Allowed: JPG, JPEG, PNG, PDF. Max: 5MB each)

Scan QR Code to Pay Rs 200/-

Scan using any UPI App (GPay, PhonePe, Paytm)

Applicant Photo *

Please upload a valid image file.

Applicant Signature *

Please upload a valid signature file.

Aadhaar Document *

Please attach your Aadhaar card.

Qualification Certificate *

Please upload proof of qualification.

Payment Screenshot with details *

Please upload your payment screenshot.

I agree to the Rules, Guidelines and Code of Conduct of the Organization. * (Click here to read and accept / পড়ার জন্য এখানে ক্লিক করুন)

You must view and accept the Rules & Code of Conduct to proceed.

I hereby declare that all information given above is completely true and accurate to the best of my knowledge. I will strictly follow the rules, guidelines and code of conduct of Jibantala Nabajagaran, If membership application is rejected same amount will be refund to the applicant, keeping humanity above anything.

You must check and agree to the declaration before submitting.