JANSANKHYA STHIRATA KOSH

(National Population Stabilisation Fund) 283, August Kranti Bhawan Bhikaji Cama Place, New Delhi 110066.

MEMBERSHIP FORM
Name_____________________________________________ Phone (O) (Mob.)_________________

Address___________________________________________ __________________________________________________ Email_____________________________________________ Registration Number in case of NGO____________________ I wish to support Jansankhya Sthirata Kosh as a Member: ( any one)

Individual (Annual Rs.100/-, Lifetime Rs. 1,000/-) Institution / NGO (Annual Rs.1,000/-, Lifetime Rs. 10,000/-) Corporate Sector (Public & Private Industry)
Gold Membership, Large Industry (Annual Rs.10,000/-, Lifetime Rs. 1,00,000/-)

Silver Membership, Small & Medium Enterprises

(Annual Rs.1,000/-, Lifetime Rs. 10,000/-) Annual Membership is from the date of enrolment to 31st March. Payment of membership fee may be made in the following manner: i) Through Multicity Cheque drawn on Core Banking Solution (CBS) branch OR
ii) Cash deposited in any branch of SBI covered under CBS (S/B A/c No.30135200719). In this case photo copy of the counter foil received by the bank should be forwarded along with the Membership Form to JSK at above mentioned address.

OR iii) Crossed bank draft in favour of JSK Membership payable at New Delhi. I am enclosing a cheque / DD No. _______________ Dt.____________ for Rs. ___________ drawn on Branch___________________ in favour of JSK Membership. SIGNATURE Please become a member to signify your support For further details, please contact JSK at:

jsk.npsf@nic.in Website: www.jsk.gov.in