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INTERNATIONAL HUMAN RIGHTS DEFENDERS

( GOVT. REGN. NO.41082201717/2022 UNDER TRUST )


INTERNATIONAL STANDARD ORGANISATION (ISO 9001:2015)
( HUMAN RIGHTS DEFENDERS & RIGHT ACTIVIST )

MEMBERS / BOARD MEMBERS JOINING FORM (REFER CLAUSE NO.3.5 OF IHRD TRUST DEED)
PAN CARD NO. AACTI0218C / 80G: URN NO. AACTI0218CF20214 / 12A : URN NO. AACTI0218CE20216
Help Line No. +91 90780 25552, Toll Free No.18002121700 Email: ihrdindiahq@gmail.com, www.ihrd.org.in
NAME OF THE ACTIVIST
(IN FULL CAPITAL LETTERS)
FATHER'S NAME / HUSBAND NAME AFFIX PASSPORT SIZE
(Mark Tick) PHOTO HERE

DATE OF BIRTH

ADDRESS IN FULL (AS PER


ADHARCARD)

EMAIL ID

PHONE NUMBERS

BLOOD GROUP

CURRENT PROFESSION

NATIONALITY

CHARACTER CERTIFICATE FROM


COMPETENT AUTHORITY:
(SARPANCH/ TAHASILDAR / LOCAL
POLICE STATION
IN CASE OF MEMBERS / BOARD
MEMBERS OF ABROAD (ATTACH COPY
OF LOCAL GOVT. OFFICER'S ATTESTED
COUNTRY CITIZENSHIP)

AREA OF POSTING & BOARD


(DIST./STATE/NATIONAL/
INTERNATIONAL)

NAME OF THE POST

BANK ACCOUNT DETAILS : "INTERNATIONAL HUMAN RIGHTS DEFENDERS", PUNJAB NATIONAL BANK,
CURRENT ACCOUT NO. 1773102100000343, IFSC: PUNB0177310, SIJIPUT BRANCH

NO OBJECTION CERTIFICATE (NOC) & SELF DECLARATION BY THE MEMBER / BOARD MEMBER

I hereby declare that, the Non-refundable Donation amount paid by me with my knowledge and belief to INTERNATIONAL HUMAN
RIGHTS DEFENDERS (IHRD), Trust Account towards Members Fee / Board Members Donation for issuance of my Identity card & Kit
etc. as well as to help needy people. Also I herewith undertake that, if any illegal activities found by me in future, I will be whole
responsibe for the same and I can not claim to INTERNATIONAL HUMAN RIGHTS DEFENDERS (IHRD).

(FULL SIGNATURE OF THE MEMBER / BOARD MEMBER)

DATE :…………………………………..
( IHRD AUTHORISED SIGNATURE WITH SEAL )

N.B. : THIS FORM WILL BE FILLED ONLY BY THE AUTHORISED PERSONNEL OF IHRD

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