Web Media membership Form

First Name*

Last Names*

Father / Spouse Name*

Date of Birth*

Sex*

Nationality*

Marital Status*

Educational Qualification*
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Permanent Address*

Present Address*

Email*

Mobile No*

District*

Language Known*
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Nature of Business*

Occupation*
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Designation

State*
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Union Territories
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District

Area Ward No/Village

Area Police Station

Name of the Proposer/Introducer

Passport Size Photo* (Required upload size: 5MB)

Signature for ID Card* (Required upload size: 5MB)

Id Proof* (Required upload size: 5MB)

(You can submit your Front and back of Aadhar card as a ID Proof as well as Address Proof.)

Address Proof* (Required upload size: 5MB)

(You can submit your Front and back of Aadhar card as a ID Proof as well as Address Proof.)

Transition Receipt* (Required upload size: 5MB)