DEPA KERALA, Dalit Employees' and Pensioners Association Kerala

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Dalit Employees' & Pensioners Association Kerala

REG No: TSR/TC/1005/2012
REGD Office 584/X

Membership Form

Name :

Age :

Family Name :

Street :

Post Office :

PIN :

Taluk :

Panchayath/ Municipality/ Corporation :

District :

State :

Landphone Number :

Mobile Number :

Email Address :

Name of the Institution :

Current Post/ Pensionable Post :

Scheduled caste / Scheduled Tribe :

Whether Spouse Working (YES/NO) :

If yes. Post and Institution :

Educational Qualification :

Areas of Interest :

AFFIDAVIT

l will work to the best of my ability for the protection of The Constitutional Rights of Dalit Employees and Pensioners as well as the unification and upliftment of Dalit community according to the by-laws of Dalit Employees and Pensioners Association Kerala on the basis of the Ideology put forwarded by Babasaheb Dr.B.R.Ambedkar.