Individual Membership Form (Renewal & Fresh) of Paschim Banga Vidyalaya Paridarshak Samity

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Individual Membership Form (Renewal & Fresh) of Paschim Banga Vidyalaya Paridarshak Samity

(Hard copy of downloaded Form to be submitted in triplicate to the CEC)

Please read the instructions carefully before filling up this form.

Email *

Record my email address with my response

District: *

Name in BLOCK Letters:
*

Designation:
*

Presently Posted at (Please specify if on deputation):
*

Present Posting since:
*

YYYY

Date of first joining in the Service as School Inspector:
*

YYYY

Qualification : *

Subject : *

Mobile No.:
*

Email:
*

Present Residential Address (with District & PIN Code):
*

Permanent Residential Address (with District & PIN Code):
*

Date of Birth:
*

YYYY

Blood Group:
*

Monthly Subscription paid
upto : (Month) :
*

Monthly Subscription paid
upto : (Year) :
*

Declaration: *

I do hereby declare that I have full belief and confidence in the aims and objectives of Paschim Banga Vidyalaya Paridarshak Samity and I do hereby declare my wholehearted commitment to the cause of the said Samity. Accordingly, I am glad to accept the membership of Paschim Banga Vidyalaya Paridarshak Samity and I hereby declare that I shall abide by the rules and regulations of the Samity, shall regularly pay the subscriptions/donations, as may be required to be paid from time to time and will refrain to act/speak in any manner prejudicial to the interests of Paschim Banga Vidyalaya Paridarshak Samity.

Required

Remarks:

Send me a copy of my responses.

Submit

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