User Application Form

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Registration Form

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Gender * :

Date of Birth * :

Profession:

Blood Group *:

State * :

District *:

Mobile No. *:

Aadhar No. *:

Address *:

Pin Code *:

Email:

Profile Picture:

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Other Document

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Membership Fee - 2000/-

Bank Detail -

Name: Mr. Basant Kumar Jangid
Account number: 10128392737
IFSC: IDFB0043101
SWIFT code: IDFBINBBMUM
Bank name: IDFC FIRST
Branch: Jaitaran Branch

UPI SCAN:

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