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Membership Form
Instructions
1) Form should be preferably filled in English and in BLOCK CAPITAL LETTERS only
2) Attach photocopy of approved Address proof, Photo ID proof & Age proof
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3) Remit Membership fee of Rs 15 or Rs 5 for Women and SC/ST (attach photocopy

of caste certificate).
Barcode
4) The completeness of this form is the SOLE RESPONSIBILITY of the member.
IYC will reject this form if any of the mandatory fields (Name, Date of Birth, Sex,
Paste recent
Fathers Name, Panchayat Name, Assembly Name or Photograph) are missing, original
even if a barcode has been issued by the LRO. photograph.
Do not staple.
State : Lok Sabha :
Assembly : Panchayat/ Ward :
First Name Last Name
Full Name :

Father/Husband’s Name :
Strike out whichever is not applicable
D D M M Y Y Y Y
Date of birth : Sex : M F Blood group :

Present Address :

City/District : Pincode :

Landline : Mobile :
* Separate the STD code and number with a dash
Profession :
Category : General SC ST OBC Minority
Email :

Declaration : I wish to apply for the annual membership of the Indian Youth Congress. I accept the constitution of
the Indian Youth Congress and I declare that -
- The information given by me in this form and enclosures is true.
- I am under 35 years of age and a Citizen of India.
- I am not a member of any other political Party.
- I have never been convicted of any criminal Signature /
offences by any court
Thumb impression :
Date : * Ensure signature / thumb impression is within the box
Acceptance of the membership form does not guarantee enrollment as a member of the Indian Youth Congress The membership fee paid along with the form is non-refundable under any circumstance

Tick Address Proof provided Tick Age Proof provided

To be filled by LRO

Assembly Code Panchayat Sl. No. □ Last 3 months Landline/Mobile Bill □ Rental Agreement □ Birth Certificate □ Sworn Affidavit in front or Executive
□ Last 3 months Water/Electricity Bill □ Drivers License □
- Passport Magistrate or First Class
□ Passport □ EPIC Voter ID □ PAN Card Magistrate or Notary Public
□ Property Tax Receipt □ National Identity Card □ Drivers License □ Certificate granted by medical
Received Rs. : ___________________ □ Current Month Bank Statement □ NREGA Job Card □ State Board Exam Certificate practitioner not below rank Civil
□ Ration Card □ LPG Receipt or School Leaving Certificate Surgeon

LRO signature : □ Govt. Fishermen ID □ EPIC Voter ID □ Panchayat Secretary/Taluk

□ Panchayat Secretary/Taluk Certificate □ NREGA Job Card Certificate

Receipt INDIAN YOUTH CONGRESS Barcode

You must produce this #5 Raisina Road, New Delhi - 110001.
Ensure that barcode
receipt during voting
sticker is pasted on the
receipt.
Full Name :
Assembly Code Panchayat Sl. No.
Received Rs.________ towards
subscription
*To be filled by LRO
- LRO Signature :
Acceptance of this form does not guarantee enrollment into the IYC Incomplete forms even with bar codes affixed will be rejected The membership fee is non-refundable under any circumstance
You can check your membership status
The IYC is Transforming ! approximately 5-6 weeks after the last date for membership in
Find out more at www.iyc.in Open
Membership
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Elections
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of Conduct
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your state - SMS BARCODE <space> <YOUR BARCODE NUMBER>
to 5676743 or visit http://elections.iyc.in

Reach us: Web : www.iyc.in Email : support@iyc.in Helpdesk : 1860-425-4357 (Monday to Saturday, 10AM to 5PM)