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Application for membership

Committee for Protection of Democratic & Human Rights (W.B.)

গণতান্ত্রিক ও মানবাধিকার রক্ষা সমিতি (পশ্চিমবঙ্গ)

Regd. Office: 28/3, Tollygunge Circular Road, Kolkata - 700 053
E-mail: cpdhr.westbengal@gmail.com Mob.: +91 983-099-8562
Read. No. S/IL/55753

To, The President CPDHR(W.B.)

Name (In block Latters) ^*

Photo (Passport size with white background) ^* Upload the image file only (jpg/jpeg/png)

Date of bitrh ^*

Blood Group ^*

Gender ^*

Male

Female

Qualification ^*

Professing ^*

Mobile No. ^*

Father / Guardian ^*

P.O. ^*

P.S. ^*

District ^*

Pin ^*

Permanent Address ^*

E-mail Id

Recommended by ^*

Unit ^*

Recommender's Mobile No. ^*

ID Proof (Any govt. document) ^* Upload the image file only (jpg/jpeg/png)

Applicant's Signature with Date ^* Upload the image file only (jpg/jpeg/png)

ID Proof (Any govt. document)

Note: Upload an attested copy of any govt. documents ( Voter Card / PAN Card / Ration Card / Driving License / Aadhaar Card )

Applicant's Signature with Date

Note: Signature on white paper with date and Upload the photocopy

I am fully aware of the activities of CPDHR(W.B.) and have also gone throught the rules and regulations of the organization. I aspire to be a member of this organization to serve the people and ensure their human rights, I promise that i shall abide by the rules and regulations of this organization. I enclosed herewith attested copy of my Voter Card / Pan Card / Ration Card / Driving License / Adhar Card along with self-photographs. I declare that the given informationare true and if any information is found incorrect / false / suppression of facts or if any illegal / immoral activity against me is proved, then my membership will be terminted immediately and CPDHR(W.B.) will not be liable for that.

^* Mandatory fields

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Committee for Protection of Democratic & Human Rights (W.B.)

গণতান্ত্রিক ও মানবাধিকার রক্ষা সমিতি (পশ্চিমবঙ্গ)

To, The President CPDHR(W.B.) মাননীয় সভাপতি সি পি ডি এইচ আর (পঃ বঃ)

ID Proof (Any govt. document)

Applicant's Signature with Date

To, The President CPDHR(W.B.)