Nehru Yuva Kendra Sangathan

Youth Club Affiliation ()/ Updation () Form

State: Himachal Pradesh District: Shimla Block: Theog

1. Name of Youth Club: Krantikari Yuvak Mandal Namana

2. Address : Village Namana Gram Panchayat Kiar Post office Kiar The Theog Pi code 171220

3. Establishment detail of Club:

a. Date of Establishment: 01/01/2021

b. Whether Registered: No

4. Infrastructure of Youth Club:

a. Does the Club has its office in the village: No

5. Membership Details of Youth Clubs: ( Individual office bearers and Members)

S. Name Gender Category Education Mobile BPL Designation

No.

1 Abhishek Male Sc Post 8894412378 BPL General

Graduate Secretary

2 Vipin Male Sc Post 7018623995 NA President

Graduate

3 Anil Male Sc Post 9459958761 NA Vice

Graduate President

4 Sunil Male Sc Graduate 8894864398 NA Cashier

5 Jitender Male Sc +2 8988290900 NA Joint

Secretary

6 Rohit Male Sc ITI 8544746909 BPL Member

7 Manoj Male Sc +2 8894414777 BPL Member

6. Whether the Youth Club has ever received Financial Assistance (Grant in Aid) from any other
Agency: NO 7. Whether Club is maintaining its account : NO

8. Whether the Youth Club has its Memorandum of Association (MoA}/ By Laws: NO

9. Area of Activities of Club: Rural Development/Youth Development/Environment

Conservation/Social Development/Economic Development/Infrastructure development.

10. NYKS Activities you would like to participate in : Sports, Life Skills, Education, Culture,
Adventure, Skill Training, Leadership & Development.

I hereby declare that the above information provided is correct and true. In this regard, the
evidence

can be produced and would be open for physical verification by NYK and designated person. It
is

certified that the Club has 7 Male and 0 Female membership as on date.

Date 20/09/2021

Place Namana

Abhishek

Signature of Youth Club

President/General Secretary