आवेदन फार्म

To,
The Editor, Lok Panchayat, New Delhi
Sir/Madam,
I wish to become a representative/correspondent for Lok Panchayat. My personal details are as follows:

Name of the area applied for:

Position applied for:

Name:

Father's/Husband's Name:

Marital Status:
MarriedUnmarried

Date of Birth:

Educational Qualification (Enclose last educational certificate):

Postal Address (enclose copy of Aadhar/Voter ID):

PIN Code:

Telephone/MobileNo.:

STD Code:

Your email

Enclosures: Bio data

Enclosures: latest color photo

Pledge:
1- I hereby declare that the information provided above is true the best to my knowledge.
2- I will faithfully abide by the rules of Lok Panchayat and I will not misuse my position.
3- I will always place the national interest above all else.

Date:

Place:

Applicant's Signature:

How many years have you known the applicant (at least 3 years):

The information provided in the application form is correct:

They have a good reputation in the community and face no criminal charges:

Name of Identifier:

(If the identifier is an office-bearer of the Lok Panchayat, provide only their identity card number)

Postal Address of Identifier:

Identifier Telephone/MobileNo.:

Advance payment for the mandatory prescribed copies: ₹

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