‫ ׀׀‬Jai Siddhnath ‫׀׀‬

SAMAST SATVARA
STUDENTS ASSOCIATION
REGISTRATION FORM

STUDENT INFORMATION
(Fill in BLOCK LETTERS only)
NAME : _________________________________________________
STUDY : _________________________________________________
COLLEGE : _________________________________________________ Kindly Paste
BIRTH DATE : _________________________________________________ Passport size
BLOOD GROUP : _________________________________________________ Photograph
NATIVE PLACE : _________________________________________________
PRESENT : _________________________________________________ (Do not Staple)
ADDRESS _________________________________________________
_________________________________________________
PERMENANT : _________________________________________________
ADDRESS _________________________________________________
_________________________________________________
MOBILE NO. : _________________________________________________
MOBILE NO.(R) : _________________________________________________
E-MAIL ID : _________________________________________________

FAMILY INFORMATION

Name Qualification Occupation

FATHER
MOTHER
BROTHER/
SISTER
• Contact us : satvara@ymail.com • Visit : www.satvara.org
__________________________________________________________________________________________
 For office use only :
Fee Received : ________________ Receipt No. : ________________
District : ________________ Recipient’s Sign : ________________
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FORM RECEIVED ON : _________________ S

REGISTRATION NO. : _________________ SSA
Sign.