ROYAL ENFIELD CLUB

MEMBERSHIP FORM

NAME : Anish N. Girme

TOKEN NUMBER : 90764

DEPARTMENT : D&E (MHE Systems)

BIKE MODEL WITH YEAR OF MFG : Classic 350, 2014

VEHICLE REGISTRATION NUMBER : MH-12 KV 0352.

EXTENSION NUMBER : 4601

MOBILE NUMBER : 9011818372

DRIVING LICENSE No:/ EXPIRY DATE : MH-12 20020279915

EMERGENCY CONTACT DETAILS(Name and
: Nandkumar Girme, 9921707056.
phone number)
BLOOD GROUP : A+

Signature: ANISH GIRME Date: 24-4-17