Please provide basic details:
fill out all information required above.
Full Name
*
Mr.
Ms.
Mrs.
Dr.
Prof.
Prefix
First Name
Middle Name
Last Name
Address
*
Enter your permanent address details as per your aadhar card
Street Address Line 2
City
State / Province
Postal Code / Zip Code
State
*
City
*
Pincode
*
Mobile Number
*
e.g. (+91)-9829123456
E-mail
*
example@example.com
Please Select ID Card Type
*
Select ID Card Type
ID Card for Membership - Independent Representative
Press ID Card - Local News Representative
Press ID Card - District News Editor
Press ID Card - State News Editor
Please Any One ID Card Type
Please give reference of any two people as emergency contact:
*
Rows
Full Name
Address
Contact Number
Relation
1
2
Upload Your Aadhar Card Front
*
Aadhar Card Front
Drag and drop files here
Choose a file
Please upload .jpg / .jpeg / .png / .png / .pdf file
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of
Upload Your Aadhar Card Back
*
Aadhar Card Back
Drag and drop files here
Choose a file
Please upload .jpg / .jpeg / .png / .png / .pdf file
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of
Upload Your PAN Card
*
Upload PAN Card
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Choose a file
Please upload PAN Card Front Only
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of
Permanent Address Proof
*
Permanent Address Proof
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Choose a file
Please upload Any Address proof
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Upload Date Of Birth Proof
*
Date of Birth Proof
Drag and drop files here
Choose a file
Please upload 10th Marksheet or Birth Certificate
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of
Upload Passport Size Photo
*
Passport Size Photo
Drag and drop files here
Choose a file
Please upload passport size professionnal photo
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of
Submit
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