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Name [Block Letters] : *
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Photo :
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: *
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Gender :
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Email :
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Contact No. 1 :*
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Signature :
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Contact No. 2 :
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Postal Address :
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Police Station :
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Post Office :
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District :
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Pin Code :
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State :
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Same as Postal Address :
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Present Address:
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Date of Birth :
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Educational Qualification:
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Age :
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Profession :*
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Profession if others :
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Member Type :
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Member/Renewal Fee :
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-
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Introduced by :
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ID No. of Introducer:
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Place :
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State :
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Submit any one documents from following :
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Aadhar Card
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Passport
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Driving License
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Voter Card
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Mandatory Documents For Non Govt. Employee:
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Character Certificate
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Declaration : I have read all the rules and regulation of the AIHRA. I declare that the above information is true and correct to my knowledge and belief and I fully understand that my application will Stan cancelled if any information by me is found to be false or twisted. After deposit membership amount is not refundable.For Membership Fees Payment Please Contact - +91 8585019091
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