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Advisor Enrollment Form

General Membership Form fields (as in the provided image).

11. Address

Line1*

Line2

Line3

City / Town / Village*

District*

State*

Pin code*

12. Contact Details (All communications will be sent on provided Mobile no. / Email ID)

Mobile* Mobile Banking will be enabled on above Mobile Number only

Alternate Mobile

Email ID*

Tel (Res)

Tel (Office)

13. Aadhaar Number*

14. PAN Number*

Nominee Details

1. Name of Nominee*

2. Relationship with Member*

3. Date of Birth of Nominee*

4. Contact Number of Nominee*

Nominee Bank Details

Bank Name*

Branch Name*

Account Number*

IFSC Code (11 Digit)*

APPLICANT DECLARATION

I, (name), hereby declare that the information provided above is true and correct to the best of my knowledge. I agree to abide by the rules and regulations of Jayalakshmi Mutually Aided Cooperative Thrift and Credit Society Ltd. I understand that my appointment as an advisor is subject to approval by the management.