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To The
Prime Minister,
Kashi Agrawal Samaj, Varanasi

I wish to apply for the lifetime membership of Shri Kashi Agrwal Samaj. I have gone through all the rules for becoming a lifetime member. I hereby declare that I will always make positive contributions in the growth of Kashi Agrawal Samaj. Request you to please accept my lifetime membership registration request. My personal details are as follows:

First Name*

Middle Name

Last Name

Father/Spouse Name*

Gotra*

Address

Landmark*

Date of Birth*

Mobile Number*

Email Address*

Password*

Business/Firm Name

Nature of Work

Proposer ID*

Proposer Name*

Proposer Mobile*

Approver ID*

Approver Name*

Approver Mobile*

Upload Photo*

Upload Aadhar Card*

Scan the QR code & make payment of ₹1,100

(Lifetime membership fee)

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