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Dastak Membership Form

Name

Father/ Husband Name

Address

House No, Building, Street

Locality, Town

City

State

Zip Code

Phone No (WhatsApp Only)

Alternative Phone No

Referred by

Date Of Birth

Blood Group

Interest in Social Activity

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Become A

Donor

Member

Donation Amount

Membership

Payment Of ₹ 5100/-

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Payment Type

Bank Transfer

Through UPI

Bank details:
Society Name: Dastak
Bank:Punjab National Bank
Branch: Kamala Nagar
SB Account No: 0154000102279348
IFSC code: PUNB0015400

Note : I hereby give my concent that I shall abide by rules and regulation of Society in all the given condition. I shall be abide by Executive committee decision of acceptance/Rejection of my membership Application Form.

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