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Friday, March 5, 2021
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National Human Rights Defenders of India
APPLICATION FORM FOR MEMBERSHIP
Name [Block Letters]
S/o-D/o-W/o
Email
Gender
—
Male
Female
Others
Contact No. 1
Contact No. 2
Postal Address
Post Office
Pin Code
Police Station
Signature
Photo
District
State
—
Andra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telagana
Tripura
Uttaranchal
Uttar Pradesh
West Bengal
Union Territories
Andaman and Nicobar Islands
Chandigarh
Dadar and Nagar Haveli
Daman and Diu
Delhi
Lakshadeep
Pondicherry
Present Address
Date of Birth
Age
Educational Qualification
Profession
select
Business
Govt Service
Non Govt Service
House Wife
Retired
Doctor
Lawer
Social Worker
Student
Other
Member Type
select
Active (Lamination card)
Special (PVC card with Certificate)
Life time (PVC card)
Silver Member (PVC card with Certificate)
VIP Member
District wise Secretary
District Convener
District Co-Convener
State wise Secretary
State Convener
State Co-Convener
Profession if others
Introduced by
ID No. of Introducer
Submit any one documents from following
Aadhar Card
Passport
Driving License
Voter Card
Mandatory Documents For Non Govt. Employee
Character Certificate
Declaration
I have read all the
rules and regulation
of the NHRCI. I declare that the above information is true and correct to my knowledge and belief and I fully understand that my application will Stan cancelled if any information by me is found to be false or twisted. After deposit membership amount is not refundable