HUMAN RIGHTS

& SOCIAL JUSTICE MISSION

GOVT. REGD. HRO18201200116
Head Office : Press Enclave Road, Connaught Place, New Delhi - 110001
National Corp. Office : C/O. Janasahyog Co -Op. Credit Soc. Ltd. A/5, First Floor,
Shankar Naidu Chawl, Chimat Pada, Marol Naka, Andheri (East), Mumbai - 400 059.
Tel : 022 - 2856 5151, Email : humanrights.socialjustice@yahoo.com, Web: www.hrsjm.org

APPLICATION FORM FOR MEMBERSHIP OF “HRSJM”

To, Date :
The President, UNDERTAKING TO BE SIGNED BY THE MEMBER
Human Rights & Social Justice Mission Respected Sir,
A/5, First Floor, Shankar Naidu Chawl, I the Undersigned Active/unit Member Pledge to
Chimat Pada, Marol Naka, Photo abide by the Rules & Regulation of Human Rights & Social
Andheri (East), Mumbai - 400 059. Justice Mission, and adhere that....

Maharashtra - India 01. I will not violate any Rules and Regulations and
discipline of our esteemed Organisation.
02. I also assure you that I will not misuse the Identity Card
Dear Sir, and my respected post bestowed to me.
Please Enrol me as...................................................................... 03. I also affirm that if norms are infringed by me or missed I
will be solely responsible for any legal proceedings
My Particular are as given below : USE CAPITAL LETTERS towards me, and my Identity Card along with my post
will stand terminated by the organisation and the
Name ........................................ Surname................................. respected Organisation’s decision will prevail on me.
Father’s/Husband’s Name .......................................................... 04. I also undertake to surrender my identity Card to the
National Admn. Office after its expiry and renewal is
Date of Birth..........................................(M/F)..................... must for continuations of Membership.
05. All dispute subjects are settling by the permission of
Profession National Admn. Office to Jurisdiction on H/R only.
Education 06. Incase of changing in my residence address I am liable
to inform the same to the National Admn. Office.
Address H.No 07. In case of loss of the Identity Card it is my responsibility
to informto the National Admn. Office in writing along
Village Post Office with the F.I.R. within two days.
Taluka District 08. I know that strict action will be taken against the
member, if found guilty floating the rules and
State ......................................... Pin Code regulations of HRSJM and are also purposes without
their permission.
Nearest Police Station 11. I know that I can’t change the format of Logo of HRSJM.
12. Active/unit Members should inform directly to Admn.
Mobile No.
office if found any type of violence against Human rights
and Social Justice.
E-mail
13. Members will take Immediate Action and inform District
Details of Bank Draft President on any Mishaps / Complaints / Evils / Criminal
Activities without any fear.
POSTAL
CATEGORY ANNUAL FEE RENEWAL FEE FOR 10 YEARS CHARGES
14. Each Member is requested to make New Members
every month.
ACTIVE MEMBER 400 300 3000 100
15. Members should visit Hospitals, Jails, Orphanage
100
WARD UNIT MEMBER 500 400 4000 Homes, Slum Areas, Schools and other Govt. offices
TALUKA UNIT MEMBER 700 500 5000 100 and submit the Monthly Report to Head office.
TALUKA PRESIDENT 1200 800 - 100 16. Members should distribute Clothes, Foods, Articles to
DISTRICT UNIT MEMBER 900 700 6000 100
the needy and poor.
DISTRICT PRESIDENT 1500 900 - 100
17. Members should Organize Seminars, Press Meetings ,
100
& Legal Awareness Camps & Monthly Janta Darbar.
STATE UNIT MEMBER 1800 1400 9000 .

STATE PRESIDENT 5000 3400 - 100

I the Active/Unit Member fully agree with the above
mentioned rules and Regulations. This is read and
LIFE MEMBER 10000 For 10 Year Only renewal fee is 5000 for next 10 year
explained to me without any coercion by the Organisation.
I hereby pledge to uphold the constitution of India & sincerely follow & abide by the objective & ideals of Human Rights & Social Justice Mission
an Organisation by the status of Human Rights & Social Justice & declare that I am not a part of any organisation that will jeopardize, the Human
Rights & Social Justice Mission’s image of impartiality. I also affirm that I will sincerely render my services without any vested interest & any type of
claims and work solely in the interest of the above said organisation. I will not violate any norms of the above said organisation and the governing body
of Human Rights & Social Justice Mission is at liberty & liberty to terminate my post and membership from the organisation immediately without any
notice. I fully accept the terms & conditions of the above said organisation & I shall have no claim whatsoever.

Sign Here
PLEASE NOTE THAT
Attach 2 passport size photo
Photo Attach Address Proof Zerox
Attach Photo ID Proof Zerox
Joining Fees Pay by demand Draft
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