Regd.
PRAGATISHEEL RAILWAY MAAL GODAM SHRAMIK SANGH
Office: Rohini Sector-22, House No. 7-8, Pocket-17, New Delhi 110086
website: www.prmgss.org | E-mail ID: manoj_creativesence@yahoo.in | M. 9555888730
MEMBERSHIP APPLICATION FORM
FORM NO.
FORM NO.
MEMBERSHIP DETAILS
Zone
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Central
East Central
East Coast
Eastern
North Central
North Eastern
North Western
Northeast Frontier
Northern
South Central
South East Central
South Eastern
South Western
Southern
West Central
Western
Division
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Shed
Designation
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Warehouse Worker
Loading Supervisor
Unloading Operator
Helper
Warehouse Assistant
Permanent Worker
Check (Goods Department)
Membership Date
PERSONAL DETAILS
IDENTIFIER ID
Full Name
Father / Husband Name
Mobile Number
Email ID
Password
Category
Aadhar Number
Marital Status
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Married
Unmarried
Other
Blood Group
D.O.B
Gender
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Male
Female
Other
ADDRESS DETAILS
Address
State
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Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Andaman and Nicobar Islands
Chandigarh
Dadra and Nagar Haveli and Daman and Diu
Delhi
Jammu and Kashmir
Ladakh
Lakshadweep
Puducherry
Pin Code
EDUCATION QUALIFICATION
Exam
Institution / University
10th
12th
Graduation
Other
BANK DETAILS
Bank Name
Branch Name
Account Number
Holder Name
IFSC Code
Type
PHOTO
SIGNATURE
LEFT THUMB IMPRESSION
Aadhar Card Front
Aadhar Card Back
E-Shram Card Front
E-Shram Card Back
Affidavit Front
Affidavit Back
I am
Son of / Daughter of
residing at
as a member of Pragatisheel Railway Maal Godam Sharmik Sangh is hereby declare that, this membership application form collected by me along with the applicants documents and union membership fees. I declared that the details of the applicant is verified by me and true as per my knowledge. I collect this membership application form following the bylaws of Pragatisheel Railway Maal Godam Sharmik Sangh. I assure that I will submit this application form along with the document and membership fees to my immediate signatory leader within 3 days. I also declared that, if any time any complaint raised regarding fraud documents or information about the membership or any complaint regarding collection of membership fees out of union bylaws or any complaint about the past criminal record of the applicant I will be responsible for that.
ID OF IDENTIFIER
IDENTIFIER'S SIGNATURE
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