INC Membership Form Provisional ID INC/MEM/6893

24, Akbar Road, New Delhi -

Member ID U P 1 8 W 0 0 1 1 9 4 5
110011

The object of Indian National Congress is the well-being and advancement of the people of
India and the establishment in India, by peaceful and constitutional means, of a Socialist State
based on Parliamentary Democracy in which there is equality of opportunity and of political,
economic and social rights and which aims at world peace and fellowship.

M O H D B I L A L
Name *

EPIC * Photo

Mobile 8 8 8 1 2 3 4 5 5 2

Date of Birth
1 0 0 4 1 9 9 7
*

State * District *

Block * Lok Sabha

*

Vidhan Sabha Booth

No.*
Panchayat / Ward* *

Category * Gen SC ST OBC Minority MBC NT/VJNT

Gender * Male Female Other

Present Address* House no 1008/19 south khalapar

Pin
Code*
2 5 1 0 0 2 City/Town Village* Muzaffarnagar

Declaration: I wish to apply for the membership of the Indian National

Congress. I accept the terms and conditions related to membership specified Signature / Thumb Impression Date:
by the Constitution of the Indian National Congress and I declare that -
- The information given by me in this form and enclosures is true.
- I am not a member of any other political Party.
- I am above 18 years of age

RECEIPT

Received Rs. 5 towards INC membership fees.

Member ID U P 1 8 W 0 0 1 1 9 4 5

Recipient Name Signature Date

www.inc.in | Email : support@inc.in

Acceptance of this form does not guarantee enrollment into the INC The membership fee is non-refundable under any circumstance By filling in your mobile no, you consent to receiving INC SMS updates. You can easily unsubscribe from these at any
time