Niswarth Indian Membership Form

City Office:

Niswarth

HIG,Tower 7, Flat 1001
Uttorayon, P.O.Matigara
Siliguri-Pin.734010
Dist: Darjeeling
Membership Application Form
Contact Details:
Name Of Applicant*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Pan Number*
Date Of Birth*

DayMonthYear
Membership:-*

Yearly membership:- Rs. 300/- p.m. or Rs.3,600/- to be paid annually.
Notes: Niswarth Ac for direct payment: ICICI Bank ac no 020801005125, MICR 734229002, IFSC ICIC0000208
Saharan House, Near Anandlok, Sevoke Road, Siliguri, 734001. Please e-mail details of payment
Cheque to be drawn in favour of NISWARTH.

All Donations will qualify for IT rebate under section 80G and 12A

*Please notify “Niswarth” for change of address or contact details.
Scan QR To Pay Directly To Niswarth
SOCIETY SPECIALLY-ABLED AND UNDERPRIVILEGED TRIBAL PERSONS OF NORTH BENGAL AND ASSAM
Basha Line, Bagracote T.G., P.O.Bagrakot, Dist. Jalpaiguri, (W.B.) Pin-734501 India Web: www.niswarth.com
Mail: niswarth123@gmail.com, Mobile: 9733101050, 9933311592
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Membership Application Form