ESWAT Membership Form Date: ___________
All Prospective Members Of Eswat Are Required To Complete This Registration Form And Return To Assigned Members Of Eswat
With Suppoting Documents
Shop No.2, Deep Tushar Chs Ltd, Padmakar Colony, Near Bank Of Maharashtra, Thakurli East - 421201
Affix A Passport Size Photo
E-mail: Exstudentswelfareassociation@[Link]
Section 1: Member Contact Information
Title O Mr O Mrs O Miss O Ms O Dr O Other, Specify: Please Tick
Full Name
Father's Name Main Telephone
Mother's Name Home Telephone
Address Mobile Phone
Town/city Email
State Adhar Card No
Post Code Pan Card No
Section 2: Membership Type And Payment Details
Member Type Description Registration Membership Fees Please Tick
Life Member Life Membership Rs. 100 Rs.3000
Annual Member One Year Membership Rs. 100 Rs.300
Payment Method O Upi O Neft/rtgs
O Cheque O Payment Gateway
Payment Details To Be
Mentioned In Detail
Section 3: Member Information
Gender O Male O Female
Occupation /job Title Date Of Birth
Qualification
Associated With Any Other Trust/
Welfare Organisation
Areas Of Your Interests
Note: As A Proof, Please Attach Pan Card, Adhar Card And (last Marksheet /leaving Certificate/ Any Dcoument Received From School.
Applications Without These Documents Will Be Rejected.
Declaration: I Agree To Abide By The Ex Students Welfare Association Thakurli Terms And Conditions And Its Bylaws.
i Have Paid My Registration / Membership Fees Totalling Rs................
Write Your Name Here
Sign
The Information Provided Above Will Also Be Used To Keep You Informed About ESWAT Events In Future.
For ESWAT Use Only:
Proposer Name
Sign
Date Received Chq/ RTGS Rec’d Payment Confirmed Receipt Issued Entered Into Database