ALL INDIA JANGAM WELFARE ASSOCIATION

(REGD: No.312/2012)

(Regd. Office; 1A, 10,Second Main Road, C.I.T Nagar, Chennai- 600035)

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Admin Office: 1609, 103 rd Street, 14th Sector, K.K.Nagar, Chennai- 600078

 Phone : 9840394285: 9940426831: 9444030609

Web site: www.allindiajangam.com

E mail:    allindiajangam@gmail.com

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1.

Name                                                :

 

2.

Father’s Name                                  :

 

3.

Spouse Name ( Wife/ Husband)       :

 

4.

Date of Birth                                     :

 

5.

Kothiram                                           :

 

6

Profession                                        :

 

6.

Address                                            :

 

7

Contact Phone Number                    :

 

8

E mail details, if any                          :

 

9

           Family details

 

 

Relation ship

     Name

Date of Birth

Qualification

 Details

 

Spouse

 

 

 

 

 

1.Son/Daughter    

 

 

 

 

 

2.

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

10

Other details, if any                          :

 

               

Declaration

  1. I declare that I …………………………………………………………………belong to JANGAM CASTE.
  2. I declare that all the particulars furnished are true.
  3. I undertake to abide by the rules, regulations, and bye laws of All India Jangam Welfare Association.
  4. I am willing to pay  Rs. 500/- being entrance fee and life subscription along with this application.

 

 

Date:                                                                                                                               Signature

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Note: payment may be made by way of cash payment to the Treasurer of the Association or by way account payee cheque or DD drawn in favour of All India Jangam welfare Association, payable at Chennai or direct payment of cash of Rs. 510 (including Bank Charges of Rs. 10/-) in any branch of                              State Bank India current Account Number: 32526190133 ,Chennai CIT Nagar Branch, Code: 3305