UTKAL PRANTIYA MARWADI YUVA MANCH
FAMILY REGISTRATION FORM
(Session 2016-2017)
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Please ensure that all * mark filed up
A. FAMILY MEMBERS DETAILS:
TOTAL NO. OF MEMBERS * ATTCHED PHOTO:
RELATIONSHIP NAME AGE BLOOD GROUP QUALIFICATION
HUSBAND * :
WIFE
B. RELATED MEMBERS OF FAMILY:
RELATION NAME AGE FAMILY ORIGIN
FATHER: GOTRA * :
MOTHER: CASTE * :
GRAND FATHER : ORIGIN PLACE * :
GREAT GRAND FATHER : EXACT VILLAGE * :
C. PRESENT ADDRESS:
HOUSE NO :   STATE:
AREA/VILLAGE:   COUNTRY:
POST:   NEAREST MYM MANDAL * :
THANA:   NEAREST MYM BRANCH * :
G.P/MUNCILPALITY/N.A.C:      
CITY NAME:   MOBILE NO * :
PIN:   ALTERNATIVE MOBILE NO. :
DISTRICT:   EMAIL ID :
D. BUSINESS DETAIL:
TYPE OF BUSINESS NAME OF CONCERN   EXACT NATURE PLACE OF BUSINESS
 
 
 
 
E. OTHER DETAILS OF FAMILY HEAD:
DATE OF BIRTH :   INCOME PER MONTH:
DATE OF ANNIVERSRY:  
CONSENT FOR
VOTER ID CARD:   BLOOD DONATION: Yes No
ARE YOU MEMBER OF UPMYM Yes No   DEVOTING TIME FOR SOCIETY: Yes No
INTRESTED MATRIMONIAL PORTAL Yes No   NAME OF FAMILY MEMBER
INTRESTED JOB PORTAL Yes No   NAME OF FAMILY MEMBER
BRIEF NOTE ON SOCIAL INVOLVEMENT & AREA OF INTEREST (IF ANY):
I do here with agree to abide all the terms and conditions applicable.
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