(Regd.

Society)
Registration No. S/63675/2008
Under XI of societies registration act. 1860 (Govt. of India)
Add:-B 168 GRD FLR, J. J. Clny, Raghubir Ngr, New Delhi-110027, India,
Contact: - 01125191507, 9716166782, 9868610610

MEMBERSHIP FORM
Please attach
Recent
Photograph
Profile

Name: Father’s Name:

Postal Address:

Permanent Address:

Phone No (Res): Office:

Mobile: Date of Birth (dd/mm/yy):

Email address: Sex:

Marital Status: No. of Dependent:

Qualifications:

Willing to serve anywhere in India: Yes No

1
Emergency Contacts:
Name: .........................................................................
Address: ..........................................................................................................
.................................................................................................................…....
Postcode: ..........................................................
Relationship: .....................................................
Tel (m): .............................................................
Tel (h): ...............................................................
Tel (w): ..............................................................

Member of any professional body/association:

Papers & Publications:

Visit Abroad
Why we prefer you for the position being applied for:

Please verify with your signature that all information you have given in this form is true and accurate.
PLEASE READ THE FOLLOWING STATEMENT CAREFULLY. IF THERE IS ANY PART YOU DO NOT UNDERSTAND,
PLEASE ASK AUXILIARY STAFF TO EXPLAIN IT TO YOU.
I certify all statements made by me on this form are true and complete to the best of my knowledge and without
consequential omissions of any kind. I also certify that I have not knowingly withheld any information that would affect this form
unfavorably. I also certify that I have no criminal record. I understand and agree that any false statement of omissions as
discussed above with respect to the information required on this application is grounds for refusal to use my services as a
volunteer or for withdrawal of any offer of volunteer assignment made to me or for the termination of my volunteer assignment.
I authorize Vishwa Kalyan Manch to investigate all matters covered by this form as well as all statements made by me on this
form.
I also agree, if assigned, that I am to volunteer faithfully and diligently, to be careful and avoid accident, to come to my
assignment promptly. I agree to abide by all present and subsequently issued applicable policies and rules of the Vishwa
Kalyan Manch. I also agree to become familiar with and abide by the Mission, Vision and Values set forth by the Vishwa
Kalyan Manch. I understand that the keeping of confidentiality of information about assignment and volenteer’s is required. If I
volunteer at Vishwa Kalyan Manch, I understand that I will be required to maintain and protect the confidentiality of Vishwa
Kalyan Manch information records, financial data and any other volunteer member and Vishwa Kalyan Manch information
obtained through my volunteer assignment with Vishwa Kalyan Manch. I further understand that violation of confidentiality
would result in immediate termination of my volunteer assignment with Vishwa Kalyan Manch.
I further understand that the Vishwa Kalyan Manch reserves the right to select the best qualified volunteer based upon all the
information supplied on the application, interview process and reference checks. That decision is final and binding.
I hereby acknowledge that I have read and understand the above statements.
(Membership fee Rs.500 + Registration fee Rs.100)

Signature & Date

Cash Receipt No. …………………………Amount………Rs.600