APPLICATION FOR MEMBERSHIP
Name: Mr./Mrs.
Father/Husband Name
Date of Birth
Sex
Present Address
Address for Correspondence
ID Proof
Upload ID Proof
Important: Please Upload JPG files only and Size must be less than 1 MB.
Occupation & Designation
Address of Occupation
Phone No.
Mobile No.
E-mail
Password
Re-type Password
By using this password, you can access your identity card.
DECLARATION
I hereby declare that I have read the Aims and Objectives and Rules & Regulations of the Bahujan Swabhiman Sangh and undertake that I shall abide by the Rules & Regulations of the Bahujan Swabhiman Sangh and shall not act or cause to act against the interest of BSS.
Date
Photo
Important: Please Upload JPG files only and Size must be less than 1 MB.
Dimensions: 35mm x 45mm
Signature
Important: Please Upload JPG files only and Size must be less than 1 MB.