DO NOT CHANGE SIZE WHILE COPYING OR PRINTING THIS FORM

Membership Form

Last Revised 280111 12.1

Instructions 1) Attach photocopy of approved Address proof, Photo ID proof & Age proof 2) Remit Membership fee of Rs 15 or Rs 5 for Women and SC/ST (attach photocopy of caste/category certificate). 3) The completeness of this form is the SOLE RESPONSIBILITY of the member. IYC will reject this form if any of the mandatory fields (Name, Date of Birth, Sex, Fathers Name, Booth No., Assembly Name or Photograph) are missing, even if a barcode has been issued.

PHOTO
Paste recent original photograph. Do not staple.

Barcode

State : Assembly :
First Name

Lok Sabha : Panchayat/ Ward :

Last Name

Booth No. :

Full Name :
Strike out whichever is not applicable

Father/Husbands Name : Date of birth

D D M

Sex

Blood gp.

Profession

Present Address :

City/District : Category : Mobile : Email :

General SC ST OBC Minority

Pincode :

Landline :
* Separate the STD code and number with a dash

Declaration : I wish to apply for the membership of the Indian Youth Congress. I accept the constitution of the Indian Youth Congress and I declare that - The information given by me in this form and enclosures is true. - I am under 35 years of age and a Citizen of India. - I am not a member of any other political Party. - I have never been convicted of any criminal offences by any court

Signature / Thumb impression :

* Ensure signature / thumb impression is within the box

Date :
Assembly Code Booth No.

Received Rs. : LRO Signature :

Last 3 months Landline/Mobile Bill Rental Agreement Last 3 months Water/Electricity Bill Drivers License EPIC Voter ID Passport National Identity Card Property Tax Receipt NREGA Job Card Current Month Bank Statement LPG Receipt Ration Card Govt. Fishermen ID Panchayat Secretary/Taluk Certificate

Tick Address Proof provided

For Office Use

Tick Age Proof provided

Birth Certificate Passport PAN Card Drivers License State Board Exam Certificate or School Leaving Certificate EPIC Voter ID NREGA Job Card

Sworn Affidavit in front or Executive

Magistrate or First Class Magistrate or Notary Public Certificate granted by medical practitioner not below rank Civil Surgeon Panchayat Secretary/Taluk Certificate

Keep this receipt carefully and make a note of your Barcode number for future reference

Receipt

INDIAN YOUTH CONGRESS

#5 Raisina Road, New Delhi - 110001.

Barcode
Ensure that barcode sticker is pasted on the receipt.

Full Name :
Received Rs.________ towards subscription

Assembly Code

*To be filled by Authorised Official

Booth No.

LRO Signature :
The membership fee is non-refundable under any circumstance

Acceptance of this form does not guarantee enrollment into the IYC

Incomplete forms even with bar codes axed will be rejected

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Reach us: Web : www.iyc.in Email : support@iyc.in Helpdesk : 1860-425-4357 (Monday to Saturday, 10AM to 5PM)

approximately 5-6 weeks after the last date for membership in your state online at elections.iyc.in

You can check your membership status