User Application Form

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RAKSHAK PUBLIC FOUNDATION

Registration Form

Name * :

Gender * :

Date of Birth * :

Profession:

Blood Group *:

State * :

District *:

Mobile No. *:

Aadhar No. *:

Address *:

Pin Code *:

Email:

Profile Picture:

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Other Document

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Membership Fee - 1100/-

Bank Detail -

Name - Rakshak Public Foundation
Account - 924020055420560
IFSC Code - UTIB0005610

UPI SCAN:

Payment Mode *:

Payment Receipt Upload:

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