Please Note: Please read the REGULATIONS and submit application if you agree. Please keep your fee payment information ready before filling the form. Details to pay fees Membership Application. Fields marked with * are compulsory APPLICANT'S NAME * PIN CODE * PHOTO * (Passport Type .jpg, .png or .gif files only)) DATE OF BIRTH * GENDER * MaleFemaleOthers QUALIFICATION * OCCUPATION * NAME OF FATHER/HUSBAND/GUARDIAN * FATHERHUSBANDGUARDIAN PRESENT ADDRESS PERMANENT ADDRESS * PHONE MOBILE eMAIL BLOOD GROUP DONATE EYE YesNoDecide Later DONATE BLOOD YesNoDecide Later INTERESTED IN RELIEF WORK YesNoDecide Later NAME OF NOMINATOR PHONE NUMBER OF NOMINATOR Select Member Type * National Membership Fee : Rs. 6000/- (RENEWAL Rs. 400 P.A.)State Membership Fee : Rs. 1200/- (RENEWAL Rs. 250 P.A.)District Membership Fee : Rs. 600/- (RENEWAL Rs. 200 P.A.)Block / Panchayat Membership Fee : Rs. 200/- (RENEWAL Rs. 100/- P.A.)Students Membership Fee : (below 18 years Rs. 100/- (RENEWAL Rs. 50/- P.A.) Note : For other than West Bengal State Additional Charges Rs. 50/- Payment Method * CashChequeBank Transfer/Deposit IF PAID BY CHEQUE CHEQUE NO DATED BANK IF PAID BY BANK TRANSFER/DEPOSIT TRANSACTION NO. DATED BRANCH NAME FOR DIRECT DEPOSIT Note: Additional Charge of Rs. 50 for cash deposit at other branch Identity Type * PassportAadhar CardDriving LicenceVoter's CardRation Card Identity Proof number * Subsidy I have read and understood the regulations of A.I.O.H.R.A.P. and accept to abide by it.