Executive Committee Members of SICJAA

Registration Form

Batch Year *Batch Year (Please Fill)

Date of Birth *

DD/MM/YYYY

Full Name (as per certificate) *Full Name (as per certificate)

Father's/Spouse's Name (as per certificate) *Father's/Spouse's Name (as per certificate)

Membership Amount (Yearly)

INR

INR 500

Donation Amount

INR

Minimum INR 5,000

Bank Intrest (Office Use Only)

INR

Expenses (Office Use Only)

INR

Net Balance in Bank (Office Use Only)Net Balance in Bank (Office Use Only)

Payment Date *

DD/MM/YYY

Mode of Payment *GPayPhonePePayTmIMPS/NEFTCASHMode of Payment

Tran. Ref. Number *Tran. Ref. Number

Purpose of PaymentMembershipDonationBank InterestExpensePurpose of Payment

Village Name *Village Name

Present City NamePresent City Name

Present State NamePresent State Name

Receipt NumberReceipt Number

Mobile Number *Mobile Number

Email IDEmail ID

@2024 Created By: Yogesh Gahtori (Astrologer & Vastu Consultant), Mobile: +91 9810092532, +91 8510092532, Email ID: yogeshgahtori@gmail.com