VEDANT AYYAPPAN TRUST
C-5, Flat no.602, Vedant Phase III Co –op housing Society Ltd, Vartak Nagar, Thane(W) - 400606
MEMEBRSHIP APPLICATION FORM
A.
1.
Identity Details
Paste your photo here
Name of Applicant (As appearing in your PAN Card).
Father/Spouse Name
2. Gender:
Male
Female B. Marital status
Single
`
Married C. Date of Birth
3. Date of Marriage
4. Nationality:
Indian
Other
5. Details of Children
NAME
1.
DATE OF
BIRTH
QUALIFICATION
Please enclose a duly attested copy of your PAN Card .
Address Details
Address for correspondence
City/Town/Village
State
2.
MARITAL STATUS
1
6. PAN :
B.
GENDER (M/F)
Contact Details
Mobile #
Tel Res
Email ID
Alternate Mobile # (if any)
Pin code
Country
BLOOD GROUP
C.
1.
Membership Details
To become a trust member you are require to pay one time Joining Membership fees of Rs.1000 and Rs. 500 there after every year
towards membership renewal fee.
2.

Are you willing to be a permanent member

Mode of payment

If cheque, please provide details of Bank/Branch:
Cash
Yes
No
Cheque
Are you willing to make a monthly voluntary contribution to the trust
Yes
No. If yes, please note the minimum expected
contribution is Rs 500. Kindly note, if needed you can also make one time contribution to trust directly.
D.
Other Details
1.
Blood group details:
2.
Are you Eligible for Blood donation
3.
Previous ailments (if any)
4.
What are your talents / things that might interest you. How do you propose to contribute (Your talents) to the trust
Yes
No
Notes:
1.
E.
The trust may request a copy of PAN Card if needed for record purpose
Other Details
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform
you of any changes therein, immediately. In case any of the above information is found to be false, untrue, misleading, or
misrepresenting, Vedant Ayyappan Trust or its members should not be held liable for it.
DATE:
PLACE:
Signature of Applicant
ACKNOWLEDGEMENT FORM
Thank you for your support to Vedant Ayyappan Trust. We acknowledge receipt of payment vide Demand Draft/Cheque
No. _________ dated ____________ drawn on ______________
Bank for Rs._____________.