Reg No. 05/28101/08574/10 ‘AREA OF WORK
(Entire India)
CONSUMER RIGHTS ORGANISATION
Registration Office - Vasant Vihar, Near Post Office, Burher, District - Shahdol (M.P.)
's/ Head Office - 101, Thapar House, Gulmohur Enclave, Yusuf Sarai Community Center,
New Dethi - 110049, India
Dede Tales)
To, Paste your
‘The Presient / General Secretary passport size
Consumer Rights Organization latest photograph
For: State President / Zonal President / District President / Tehsil President
Sir,
| want to take the lifetime / Patron membership of The Consumer Rights Organization for which am
depositing the Lifetime Membership fee of Rs, 300/- (Rupees Three Hundred Only)/ Rs, 1000/- (Rupees One
‘Thousand Only) for patron Membership. Therefore, Kindly, register me as a Lifetime / Patron member of the
organization. a
Ihereby declare that | am ready toabide t y:herales and ‘sUbrules of the consumer rights organization
in their present / current form or wher they are updated from time'to time,
| promise to be loyal to wards'the tmission of the organization and Would follow all those rules and
regulations that are given to me by arganizatiod fo fulfil ls mission,
‘The necessary details reladted to me are as follows =
{.FullName
2. Name of Father/Husband
3. Full Address.
a “Telephone / Mob.
4. Occupation. 5, Date of Birth
Date
Place :, Signature of the Applicant
RECOMMENDATI
State / Zonal / District /Block’J Tehsil Corimitee
Me. Mis, (Miss, has been recommended to be the
Lifetime / Patron Member of the consumer Rights Organization
‘The Applicant has deposited the necessary fee of Rs, 300/- (Rupees Three Hundred Only) /Rs. 1000/- (Rupees
‘One Thousand Only)
The erceipt No. has been deposited on date
President
FOR HEAD OFFICE USE ONLY
Mr. / Mes, Miss. has been declared as the Lifetime / Patron Mem-
ber of the Organization.
HelShe has been assigned an Identity Card with the Membership No.
His/ Her membership fee with Receipt No. thas been received on date,
National Secretary
National Treasurer
NOTE : For the Lifetime/Patron membership. itis necessary to send three copies of your passport size