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PAM SL. No. ...... MEMBERSHIP FORM

PURVANCHAL ADHIVAKTA MANCH, DELHI (REGD. NO. 64172)

TO, THE HONY. PRESIDENT/SECRETARY
PURVANCHAL ADHIVAKTA MANCH DELHI

Dear Sir, Kindly enroll me as a RENEWAL/NEW member of PURVANCHAL ADHIVAKTA MANCH, DELHI (REGD. NO. 64172). I undertake to abide by the rules and regulations of the Purvanchal Adhivakta Manch (Regd.).

Advocate Details

Bar Council (State)

Enrollment No.

Name of Bar Association

S.I. No.

Date

Personal Information

Name of Advocate

S/W/D of

Date of Birth

Blood Group

Contact No.

Address Details

Chamber/Office Address

Residential Address

E-mail

WhatsApp No.

Membership Payment Details

I hereby pay Rs.120 as membership fee and advance subscription for one Year from:

Subscription Start Date

Payment Mode

Cheque/DD/Cash No.

Payment Date

Bank Name (for Cheque/DD)

Additional Information

Native Place and Address

Emergency Contact No.

Recommendation

Recommended By

Enrolment No.

Contact No.

Applicant Signature

Recommender Signature

RECEIPT & CONTACT INFORMATION

Email: advocatevikassingh@yahoo.in

Contact Numbers: 9518068661, 9871962144

Purvanchal Adhivakta Manch, Delhi (Regd. No. 64172)

Contact us

Chamber no. 609 Block-F Karkardooma Court, Shahdara, New Delhi, Delhi 110032
info@purvanchaladhivaktamanch.in
(91) 9818068661