SENIOR CITIZENS COUNCIL OF DELHI

(Registered under Societies Registration Act, 1860)

____________________________________________________________________________
Associated by the Ministry of Social Justice & Empowerment, Government of India, Department
of Social Welfare, Govt. of NCT of Delhi, Indian Council of Cultural Relations, Senior Citizens
Cell of Delhi Police and Bhagidari Cell of Govt. of NCT of Delhi
Registered Office: B-2/73-B, Safdarjung Enclave, New Delhi-110029
Phone:011-26197711 Mobile: 98104-88059: E-mail:guptajr2005@gmail.com
Website :www.seniorcitizensdelhi.org
The President,
Senior Citizens Council of Delhi
New Delhi
Sub: Application for Life membership
Sir,
I am a senior citizen, over 60 years of age. I would like to be a Life Member of the
Senior Citizens Council of Delhi, and therefore remit Rs.1200/- (Rupees One Thousand Two
Hundred only) by cash/cheque as my registration and subscription for Life Membership. I have
read the rules and regulations of the Council and agree to abide by them.

1 Full Name (in Block letters) ___SWARAN MITTAL_________________

2 Name of Father/Husband_______JAI PRAKASH MITTAL___________

3 Sex Male/Female __________FEMALE________________________

4 Date of Birth _______________________01/10/1956________________

5 Residential Address __WZ-650A, STREETNO.2, SRI NAGAR, SHAKUR BASTI

_DELHI --110034__________________________

6 Phone ______________Mobile 8510892777______E-mail_________________

7 Occupation : HOME MAKER

8 Payment details: Cheque No.___________ dated_________ drawn on__________

Date ____________ Signature of Applicant

Admitted.

Signature of the President Issued Receipt No. _______dated ________for________

(Treasurer)

NOTE: (1) ANY PAYMENT MADE TO THE COUNCIL IS EXEMPTED UNDER SECTION
80G(5)(vi) OF THE INCOME TAX ACT 1961
(2) Please also issue separate cheque of Rs. 500/- (Rupees Five Hundred Only)
as Life Subscriber for Monthly newspaper Elderly News along with one photo.