Ashadip PSC

Member Name 1 *

W/o or D/o or S/o *

Designation *

Occupation *

Mobile No *

Email ID *

Full Address with Pin No *
(Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)

Pan No *

Aadhaar No *

Passport Photo *
Scan in 300 dpi color, JPEG/JPG Format

Member Name 2 *

W/o or D/o or S/o *

Designation *

Occupation *

Mobile No *

Email ID *

Full Address with Pin No *
(Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)

Pan No *

Aadhaar No *

Passport Photo *
(Scan in 300 dpi color, JPEG/JPG Format)

Member Name 3 *

W/o or D/o or S/o *

Designation *

Occupation *

Mobile No *

Email ID *

Full Address with Pin No *
(Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)

Pan No *

Aadhaar No *

Passport Photo *
(Scan in 300 dpi color, JPEG/JPG Format)

Member Name 4 *

W/o or D/o or S/o *

Designation *

Occupation *

Mobile No *

Email ID *

Full Address with Pin No *
(Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)

Pan No *

Aadhaar No *

Passport Photo *
(Scan in 300 dpi color, JPEG/JPG Format)

Member Name 5 *

W/o or D/o or S/o *

Designation *

Occupation *

Mobile No *

Email ID *

Full Address with Pin No *
(Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)

Pan No *

Aadhaar No *

Passport Photo *

Member Name 6

W/o or D/o or S/o

Designation

Occupation

Mobile No

Email ID

Full Address with Pin No
(Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)

Pan No

Aadhaar No

Passport Photo
(Scan in 300 dpi color, JPEG/JPG Format)

Member Name 7

W/o or D/o or S/o

Designation

Occupation

Mobile No

Email ID

Full Address with Pin No
(Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)

Pan No

Aadhaar No

Passport Photo
(Scan in 300 dpi color, JPEG/JPG Format)

Name *
Address *
Email *
Phone No *

Organisation Name *
Registration No *
Date of Registration * (dd-mm-yyyy)
NGO Darpan Registration ID *
Pan No *
Nature of Organisation *
Date of Renewal (dd-mm-yyyy)
Mobile No *
Land Line No *
Email ID *
PMFS Portal Unique Id
Full Address and Pin Code * ( Please Mention - Vill/At. + P.O + P.S + Block + Dist. + Pin No + State )
Nearest Landmark *
Area of Operation *
Organisation Bank Name *
IFSC Code *
Account No *
Account Type *

Type	SHG JLG
Name
Registration No
Full Address with Pin No (Please Mention - Vill/At. + P.O + P.S + Block or Municipality + Dist. + Pin No + State)
Group Member Details

SHG Beneficiary Details Format click on below for download beneficiary format Beneficiary Details Format.xlsx
SHG Details click on below for download beneficiary format SHG Details.xlsx
Other if Any
Organisation Registration Certificate *
OrganisationPan Card *
Memorandum
Organisation Bank Passbook

CENTRAL AND STATE GOVT VARIOUS MINISTRY/DEPARTMENT EMPANELMENT AND REGISTRATION

Form - Rashtriya Mahila Kosh Registration

Total Expenses : Rs 2950/-

:: Contact Person Details ::

ORGANISATION DETAILS

CHIEF FUNCTIONARY DETAILS

ORGANISATION BODY MEMBER DETAILS

SHG or JLG DETAILS

DOCUMENTS

(Scan in 300 dpi color, JPEG/JPG/PDF Format)

SPONSORED INFORMATION AND FINAL SUBMISSION

Our Team

ARPITA CHAKRABORTY BANERJEE

Jharna Mallick

DEBIKA SUBBA

Chhanda Barik

Rabina Kumari Sharma

Gopal Bera

Kiran Bala Dey

Nisha Sarki

PRIYA BISWAKARMA

ANINDITA ROY

Contact Info

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ASHADIP PSC

Sponsored Name	Yes No
IF Yes, Give the Sponsored Username