national welfare team

Genarel Information
Basic Details
Personal Information
Relative Dertails
Physical Information
Other Details
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Success

General Information:

Full Name*

Sex*

male

Female

Other

Age*

Permanent Address*

Place Of Birth*

State*

Basic Details

Present Address*

Religion*

Caste*

Mother Tongue*

Educational Qualification*

Doctorate

Post Graduation

Graduation

12th Pass

Matriculation

Below Matriculation

Language Known*

Bengali

Hindi

English

Personal Information :

Marital Status*

Unmarried Married Widow Widower

Occupation*

If No Occupation How To Lead Life?

Details About Your Property :

Pension :

Are you willing to transfer that money in the name of the institution ?

Yes

If you have mobile and immovable property give details of the same :

Details Regarding The Relatives:

Father's Name*

Mother's Name*

Husband/Wife's Name

Brother/s

Sister/s

Son/s

Daughter/s :

( If any of the above is dead add late as prefix )

Other Details :

Are you willing to join this institution ?

Yes

If Yes What Work Can You Do ?

Cooking

Cleaning

Washing

Gardening

Other Mention Clearly

To which work you have an aptitude ?

Details Of The Person Who Give Surety

Donation per Month

Endowment in Lump sum

*Donation in domain shall not be refunded under any circumstances*

In case of serious illness who would look after

In case of death the details of person who would do the funeral

Should this institution perform the funeral of the deceased ?

Yes

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PS*

The information given in this application and the enclosed will are true to the best of my ability. In case any information is omitted or in case or defective information if the admission ceased, I am ready to leave this institution. I am aware of the rules of this ashram and I am committed to accept and abide by the rules.I also relieve the office Bearers and Staff of this institution of any responsibility from any damage to my body or belongings.I also abide by the rules which the institution imposes from time to time in every matter the decision of the comities is final and I hereby endorse my commitment to the rules and regulation of the institution.

Address of the guardians or guarantor

Signature of the applicant or thumb impression.

Application Form For Oldage Home

General Information:

Basic Details

Personal Information :

Details Regarding The Relatives:

Physical Information :

Other Details :

Read Out :

SUCCESS !

You Have Successfully Signed Up