Oilfield Private Employees’ Association, Tinsukia

Moto : Unite, Work and Globalise

OFFICE ADDRESS -
Lohari Patti, Near Makum By-pass, P.O. - Makum Jn. - 786 170
e-mail : oilfieldpemployees20@gmail.com
Estd. : 2020

MEMBERSHIP FORM
A. Personal Details :
(Fill in capital letters only)

1. Name in full :...........................................................................................................................

2. Father’s Name :...........................................................................................................................
3. Date of Birth :..................................................................
4. Permanent address:...........................................................................................................................
............................................................................................................................
5. Current Address :...........................................................................................................................
............................................................................................................................
6. Blood Group :................................................ Contact No. :...........................................................
7. e-mail :................................................................... Whatsapp No. :..................................
8. Gender ( ) : MALE FEMALE
9. Marital Status ( ) : MARRIED UNMARRIED

B. COMPANY DETAILS THAT YOU ARE WORKING TILL DATE (If yes) :
1. Company name in full :..................................................................................................................
2. Present designation :..................................................................................................................
3. Company office address :..................................................................................................................
............................................Office Contact No. :............................................
4. Name of MMC contractor :..................................................................................................................
(If you are working under MMC)

C. EDUCATIONAL QUALIFICATION/EXOPERIENCE DETAILS (If yes) :

1. Highest obtained educational qualification :......................................................................................
2. Technical educational qualification (If yes) :......................................................................................
3. Work experience (Technical only) :......................................................................................

1.
2.
3.

I ........................................................................ hereby declare that all the informations submitted by me

are correct, true and valid.

Applicant’s Signature

APPLICATION ID :

Sign. of Authority