Reg No. 05/28101/08574/10 ‘AREA OF WORK (Entire India) CONSUMER RIGHTS ORGANISATION Registration Office - Vasant Vihar, Near Post Office, Burher, District - Shahdol (M.P.) 's/ Head Office - 101, Thapar House, Gulmohur Enclave, Yusuf Sarai Community Center, New Dethi - 110049, India Dede Tales) To, Paste your ‘The Presient / General Secretary passport size Consumer Rights Organization latest photograph For: State President / Zonal President / District President / Tehsil President Sir, | want to take the lifetime / Patron membership of The Consumer Rights Organization for which am depositing the Lifetime Membership fee of Rs, 300/- (Rupees Three Hundred Only)/ Rs, 1000/- (Rupees One ‘Thousand Only) for patron Membership. Therefore, Kindly, register me as a Lifetime / Patron member of the organization. a Ihereby declare that | am ready toabide t y:herales and ‘sUbrules of the consumer rights organization in their present / current form or wher they are updated from time'to time, | promise to be loyal to wards'the tmission of the organization and Would follow all those rules and regulations that are given to me by arganizatiod fo fulfil ls mission, ‘The necessary details reladted to me are as follows = {.FullName 2. Name of Father/Husband 3. Full Address. a “Telephone / Mob. 4. Occupation. 5, Date of Birth Date Place :, Signature of the Applicant RECOMMENDATI State / Zonal / District /Block’J Tehsil Corimitee Me. Mis, (Miss, has been recommended to be the Lifetime / Patron Member of the consumer Rights Organization ‘The Applicant has deposited the necessary fee of Rs, 300/- (Rupees Three Hundred Only) /Rs. 1000/- (Rupees ‘One Thousand Only) The erceipt No. has been deposited on date President FOR HEAD OFFICE USE ONLY Mr. / Mes, Miss. has been declared as the Lifetime / Patron Mem- ber of the Organization. HelShe has been assigned an Identity Card with the Membership No. His/ Her membership fee with Receipt No. thas been received on date, National Secretary National Treasurer NOTE : For the Lifetime/Patron membership. itis necessary to send three copies of your passport size