D - INDIA FOUNDATION

(NON POLITICAL, NON PROFIT AND NON EARNING NGO)

MEMBERSHIP APPLICATION FORM

(Please fill up this form only when you are sure about the credentials of the candidate)

1. Name______________________________________________
2. Fathers Name_______________________________________

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3. Permanent address of the application:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________PIN________________

2. The opinion of the executive committee

about
________________________________

Police Station __________________________

(a) Applicant -- Average

Above average - Good

5. Date of Birth ________________________ Age ___________

6. Educational Qualification ______________________________
7. Married or Single ____________________
Spouses Name ________________________
Qualification __________________ Age ___________________
8. Applicants Occupation:
(Please give details i.e. if in service)

(b) Spouse -- Average

Above average - Good
4. Date of letter issued to proposer and to
references about their personal
opinion_____________________________
_____________________________
5. Date of replies so received
________________________________

a) Govt. Service - Gazetted / Non - Gazetted - Department

_____________________________________________________

6. Date Balloting
________________________________

b) If Private sector Name of the organisation

_____________________________________________________

7. Date of enrolment _______________

Probation period up to _____________

9. If in business, the nature and name of the firm

_____________________________________________________

8. Money Receipt
No._____________________________

10. Present annual income :

Less than Rs.1,00,000/between Rs.1,00,000/- to Rs.5,00,000/Above Rs.5,00,000/-

9. I.D. Card No.

__________________________allotted

PAN Card. No ___________________________

10. File No._______________________

Ledger Folio if any _________________

Name of your Bank. ______________________

11. Photograph of Self and Dependents

A/c. No. ______________________________________________

12. Date of Completion of Probation

period __________________________

11. Is he a holder of any Credit Card, or Passport, if yes, give details

_____________________________________________________

Secretary

12. Name of address of three references (other than club membership)

Aims and objectives of the organization:

(a) __________________________________________

Age ___________

o
o

o
o

Create public understanding on the

situation of Dalits and their right to
equality.
Promote exemplary Dalit leadership
to address the issue of social justice
Promote Dalit art and culture for
development and empowerment of
dalits.
Promote Dalit women leadership.
Eradicate untouchability, social
discrimination and caste-based
atrocities, with special focus on Dalit
women.
Provide support for livelihood minimum wages, education, health,
housing and insurance for labourers
in the unorganized sector.
Rights over land, water bodies,
villages, forests and other means of
production.
Create public understanding and
favourable public opinion

Eligibility of Members:
To become member of the
organization for any person following
eligibility conditions must be fulfilled
He must not be below 18 years
He should be an Indian Citizen
He has taken oath to fallow the rukes of
the society
He should be good character.
He should know read and write.
Cessation of the Membership and
Readmission:
The Governing Board may
terminate the membership and of any
Member who:
Fails to pay the required subscription;
Who does not comply with any of the
conditions stipulated by the Governing
Board in this behalf or for any other
sufficient cause;
A Member shall also cease to be a
Member if she / he resigns at her / his
own will or is of unsound mind, becomes
dead insolvent or is convicted of a
criminal
offence
involving
moral
turpitude. A member who had ceased to
be Member may however, be re-admitted
on fulfillment of such conditions as may
be laid down by the Governing Board in
this behalf;

Applicant Signature

Occupation ________________

Address __________________________________________________________________
(b) _________________________________________
Age ___________

Occupation ________________

Address
_________________________________________________________________________
(c) __________________________________________
Age ___________

Occupation ________________

Address __________________________________________________________________
13. Name of a member of the ACC known to him, other than proposer
ACC. I.D. Card No._____________________________
Name ___________________ Relation ____________
14. Has he been prosecuted in the Court of Law for any offence in the past:
Yes/No
If yes, for what _______________________________________________________________
15. Has be been a member of any other Association in India?
____________________________________________________________________________

FOR PROPOSER
(The proposer MUST BE A member of the D-India Foundation with clean records)
I know Shri. ________________________ for last _____________ (years) and
before filling his candidature, I have personally checked his credentials. All the particulars
furnished above are correct to the best of my knowledge, and I take moral responsibility for
his behaviour in the society.
Name of the Proposer _____________________ I.D. Card No.__________________
(Block letters) Signature __________________________________________________

CONSENT
I hereby declare that all the particulars mentioned above are correct to the best
of my knowledge and I agree to be an Ordinary member and have gone through Society Rules
and Byelaws and undertake to abide by the same. I also know the society manners and
attitudes.

Place:
Date :

Applicant Signature