i (Membership Form Fi ix your Bate recentcolor | Delhi Public Library Photog@Ph | oxsin of Cultre, Govt. of India Organization) Aadhar Card No. Form Serial No.: ‘TypelofMemership Needed: Child Membership/Adult Membership (ick whiceveris applicable Cd DVD Membersipidult Membership (Mrs um. De Surname:__Name: 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 (Ds taken by them. Office Address: "Telephone No. Introducer Details: Signature Know the applicant and verify his/her signature, address and also recommended to be a member of the Delhi Public Library, “(Should be attested by a MPIMLAICouncilorIGazetted Officer! ‘MBBS! BAMSIBUMS Doctor, RWA.ete) Nam Design + Office Address Office/PermanentiAlternate Address: ‘Telephone/Mobile Ne E-mail Mobile (Space of Stamp) Signature Landline : (For Office Use) ‘Membership No. Date of Bxpiry 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 Electricity Bi/MTNL Bil. WABI Received. Signature of ICwaerat wrt praia’ (aera werd Pree: Weert YEH F 20/-) fara farett uf orgatt daa faqurfiat & fem: (ate f sirerm, rer wre wT FTE) “ere rere ere EAE TW: onare re vat ae. ter ee: We HEHE / HUE BEET oo : same & wed 8 arar/ftet at two: (18 ae & zH oq) (Aeterna Jar fen em) a fetter hath eT to at sh reek agri et, ————___ air 3 st am st get ata ‘eset aera eh a Prat et argues abner = bie varie =r see a rein § —___ sftaras wer cae ff Fevis__ ar. wi stone ssi arg, feinegereett (Yar Frame erm) ser: ice at ets art wen se ear, TH a GPE roar Xe 8 feet wees erga eT ArT aT St one «tase art sree (a te ere cee ran aie eA ATER, RRR TET, CRE, UT a TATE) a — wr. wrasse a: ae ite erg tet ot Face at te irae ent afc ‘aan actors i oar Paced flees erga & weer 82 tet ft awa a SaeEH ¥, BT Tee wy arte reste ( fests ike) (circ ee mr rs a qn a a Area eeu dd) ors BT wee farm: Fam (anh