Cabinet Form 2023-2024

Last Date to submit the form 21st May 2023

Submit the form today

All field marked as * are mandatory to fill this form.
Please keep a latest photo and payment details ready when filling the form.

For online Payment Bank details are as follows :

Account Number: 349801010036319
IFS Code: UBIN0534986
Account Type: Current
Account Name: Lions Clubs International District 3234H1- Incidental Expenditure
Name of Bank: Union Bank of India
Branch: Nagpur-Gokulpeth Branch, Nagpur - 440010

Kitchen Kitchen Cabinet: 13,000/-

Cabinet Cabinet Member: 9,000/-

Name of Cabinet Officer: Lion *

Ln. Sudhir Shrivastav MJF
Title First Name Last Name

Club Name: Lions Club of *

NAGPUR NORTH

Membership Number: *
4917245
 Cabinet Form 2023-2024
Last Date to submit the form 21st May 2023

Mobile Number: *
+91 8237622220

Whatsapp Number: *
+91 8237622220

Photo: *

2d932b5a-c036-43af-824a-3e570b549996.jpeg

Address *
D-204 Harsh Apartment
Street Address

Sujata layout Deendayal Nagar

Address Line 2

Plot no 85,86 Nagpur -440022

City State/Region/Province

Maharashtra India

Postal / Zip Code Country

Email Address: *
sudhir.shrivastav123@gmail.com

Occupation: *
Project Management Consultant
 Cabinet Form 2023-2024
Last Date to submit the form 21st May 2023

Year of Joining: *
2000

Presidential Year: *
2021

Blood Group: *
A B AB O

Blood Group:
+ve -ve

Date of Birth: *
20-Sep-1968
dd-MMM-yyyy

Name of Spouse:
Ln. Nirja Sudhir Shrivastav
Title First Name Last Name

Date of Birth of Spouse:

01-Mar-1975
dd-MMM-yyyy

Date of Anniversary:
01-Feb-1999
dd-MMM-yyyy

Post held in Cabinet till now with year...

(If applying for the first time in cabinet Please fill as NA) *

Zone chairperson
 Cabinet Form 2023-2024
Last Date to submit the form 21st May 2023

Three Choices for Cabinet Portfolio: *

Any responsibility by District

Payment Method: *
Cheque Online Cash

Amount: Paid Rs. *

13000

Details : *
317300183456
State Cheque Number / UTR Number / Transaction ID / Cash given to (In case of cash) State the name to whom you have handed the Cheque /
Cash.

Upload proof of payment.

IMG_6751.jpeg

Terms and conditions *

Yes, I do.

We agree to the term and condition of Lions Clubs International as well as District 3234 H1 and abide by them.