DO NOT CHANGE SIZE WHILE COPYING OR PRINTING THIS FORM

Membership Form

Instructions 1) Attach photocopy of approved Address proof and Age proof. Either Address or Age proof must have the applicants photograph on it. 2) Remit Membership fee of Rs 15 or Rs 5 for Women, SC/ST and BPL card holders (attach photocopy of caste certificate or BPL card as applicable). 3) 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, Fathers Name, Booth No., Assembly Name or Photograph) are blank, even if a barcoded receipt has been issued.

Last Revised 101011 14.0

PHOTO
Paste recent original photograph. Do not staple.

Barcode

State : Assembly :
First Name

Lok Sabha : Panchayat/ Ward :

Last Name

Booth No.

Full Name :
Strike out whichever is not applicable

Father/Husbands Name : Date of birth

D D M

Aadhaar No

Present Address :

City/District : Sex : Mobile : Landline :

* Separate the STD code and number with a dash

Pincode :
Female

Male

Category : General Email : Blood group

SC

ST

OBC

Minority

@ Profession

Declaration : I wish to apply for the 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 offences by any court

Signature / Thumb impression :

* Ensure signature / thumb impression is within the box

Date :
Assembly Code Booth No.

Tick Address Proof provided

Tick Age Proof provided

Received Rs. : LRO Signature :

For Office Use

Passport Ration Card Drivers License EPIC Voter ID National Identity Card Aadhaar Enrollment Letter

Birth Certificate Passport PAN Card Drivers License State Board Exam Certificate or School Leaving Certificate Ration Card EPIC Voter ID Aadhaar Enrollment Letter

Keep this receipt carefully and make a note of your Barcode number for future reference

Receipt

INDIAN YOUTH CONGRESS

#5 Raisina Road, New Delhi - 110001.

Barcode
Ensure that barcode sticker is pasted on the receipt.

Full Name :
Received Rs.________ towards subscription
Assembly Code

*To be filled by Authorised Official

Booth No.

LRO Signature :

Acceptance of this form does not guarantee enrollment into the IYC Incomplete forms even with bar codes axed will be rejected The membership fee is non-refundable under any circumstance By lling in your mobile no, you consent to receiving IYC SMS updates. You can easily unsubscribe from these at any time.

The IYC is Transforming !

Find out more at www.iyc.in
Open Membership Internal Elections Code of Conduct Professional Training Nationwide Programs Performance Management

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

approximately 6-8 weeks after the last date for membership in your state online at elections.iyc.in

You can check your membership status