User Application Form

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पुनर्जागरण न्यास ट्रस्ट

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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रजिस्ट्रेशन शुल्क 100/- मात्र प्रति माह

Bank Detail -

Punarjagran NYAS TRUST

*Bank account no*

6344002100004064

*IFSC code*

PUNB0634400

ब्रांच कोड -

634400

UPI SCAN:

Payment Mode *:

Payment Receipt Upload:

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