Membership Registration

Membership Registration form

Membership Type

Name

Date of birth

Phone

Alternate no

Educational Qualification

Others

Blood Group

Referred by:

District

LAC

Anchalik Committee

Branch Committee

Post Office

Panchayat/VCDC

Address (House No, Village etc.)

State

Male

Female

Total Member

Type of House

Land Ownership Status

Vehicle Owned

No of 2 wheeler

No of 4 wheeler

Under Belt & Block

If Yes? Write here

Autonomous Council?

Select Council

Are you a beneficiary of any Government Scheme?

Mention

Number of Family members who are Government Employees

Photo

Maximum file size: 0.5MB

Terms and conditions

Self-Declaration

If you are human, leave this field blank.

All Assam Gorkha Students’ Union