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Aadhar Card No. Form Serial No.:
‘TypelofMemership Needed: Child Membership/Adult Membership
(ick whiceveris applicable Cd DVD Membersipidult Membership
(Mrs um. De
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Father's/Mother’s/Name/Husband’s Namet
Date of Birth: Date Month.
‘Age: Sex: Male/Female (/ Tick) Qualification:
Residential Addres
9, Membership Charges Re. 20/:)
Only for Students :
‘Name of the SchooW/Callege/Oceupation with Complete Address
Clase/Course of Study:
"Declaration by parent in ease of Minor: (Below 18 Year)
1___on the behalf of my SomDaughter
bide ty the Rules of DPL for Books
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Know the applicant and verify his/her signature, address and
also recommended to be a member of the Delhi Public Library,
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‘MBBS! BAMSIBUMS Doctor, RWA.ete)
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Category : Studont/Employed/Unomployed/Retired/HousewifevOthers
‘Are you existing member of DPL : YESINO
tes, since State the Membership Nox
Signature of the Candidate (With Date)
Details of address proof provided : Andhar Card/Ration CarW/Blection
T-CardOfie -CardPaseport/Driving License/Bank Pass BookiCurrent
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