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DIRECTORATE OF CIVIL DEFENCE: GOVT. OF N.C.T.

OF DELHI
FORM "C"

MEMBERSHIP CERTIFICATE

CIVIL DEFENCE CORPS

1. Enrollment No. : 90760000125341

2. Enrollment Date : 22/07/2020

3. Name of District : SOUTH EAST

4. CDV Division : JAITPUR

5. Name of Applicant : LAKSHAYA SINGH

6. Name of Father : DEVENDRA SINGH CHAUHAN

7. Gender : MALE

8. Date Of Birth : 11/11/2000

9. Identification Mark : MOLE ON FACE

10. Nationality : INDIAN

11. Mobile No : ******1168

12. Email Id :

C-10 HARSH VIHAR HARI NAGAR EXTN III SOUTH DELHI


13. Present Address :
JAITPUR DELHI 110044 INDIA

14. Name of Civil Defence Corps In which Deployed : TRAINING SERVICE

15. Assignment :

15. Name & Address of Next of kin : SANJAY SINGH CHAUHAN R/o

Signature/Thumb impression of worker


16. : --
(Left hand Men/Right hand Woman)

Digitally signed by PREM RAJ KAUSHIK,


SDM,
2020.07.25 13:18:00

90760000125341
Date of issue Office stamp of Issuing Authority Signature & Seal of Zonal Controller

1-0 22/07/2020 13:39:11

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