Bristol Online Services Pvt. Ltd.

Office: 421/1617, Infront of Xavier International School, Patia, BBSR, Orissa-751024 Ph.- 0674-6410344 Mobile- 09338291208 Website: www.bristolindia.org

MEMBERSHIP APPLICATION FORM

WRITE ALL DETAILS IN CAPITAL LETTERS:

NAME: FATHER NAME:

DATE OF BIRTH: MALE / FEMALE: ADDRESS:

TOWN: STATE: TELEPHONE NUMBER- RESI.: MOBILE NO: VALID EMAIL: EDUCATIONAL QUALIFICATION: OCCUPATION: EXPERIENCE: years

DISTRICT: COUNTRY: OFFICE:

PINCODE:

Yes! Im interested in Form Filling Job offered by www.bristolindia.org

MEMBERSHIP FEES PAYMENT DETAILS

: (Cash / Cheque / Draft / Fund Transfer)

Receipt/Payment

If Cash/Direct Deposit or Fund transfers: Rs. no: Here Im sending a Demand Draft/At per Cheque of Rs.

Drawn from Bank:

Dated:

DD No.: in favour of Bristol Online Services Pvt. Ltd Payable at Bhubaneswar, Orissa. Kindly send me the account details to my E-mail Address. Given below are my Details.

MY ACCOUNT DETAILSUsername will be allotted by www.bristolindia.org. Just write your desired Password Below
Password: MEMBERSHIP TYPE- Please Tick 1. PLAN-A Membership Fee - Rs. 3,200.00/2. PLAN-B Membership Fee - Rs. 4,400.00/3. PLAN-C Membership Fee - Rs. 5,600.00/4. PLAN-D Membership Fee- RS. 6,600.00/No. of Accounts / ID: Payees Name: I want my monthly payment by (Please Tick) As per Cheque / Demand Draft: Fund Transfer: (optional)

In case of fund transfer to your bank account please fill the below details1. 2. 3. 4. 5. Account Holder Name: A/C No.: Bank Name: Account type: Savings: Current: Bank Branch Name & Address:

I have received a copy of Terms & Conditions and Important Instructions I shall honor all changes that may be incorporated in the terms and
conditions from time to time. I understand that changes incorporated in Bristol amounts to official communication to me.
Online Services Pvt.Ltd

and agree to abide by the same.

official website

PLACE: DATE:

(CANDIDATES SIGNATURE)