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JAIN RELIEF FOUNDATION
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Username
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Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.
E-mail address
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Password
*
Confirm password
*
Provide a password for the new account in both fields.
Mobile Number
*
Personal Details
Full Name
*
Enter your Full Name as per records, same name will be displayed on the card
Father Name / Husband Name
*
Gender
*
Male
Female
Blood Group
- None -
A+
A-
B+
B-
AB+
AB-
O+
O-
Blood Donation Frequency
- None -
3 Months
5 Months
6 Months
7 Months
9 Months
Yearly
Last Blood Donation Date
Date
E.g., 2022/06/23
Address
Country
*
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caribbean Netherlands
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R., China
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao S.A.R., China
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Address 1
*
Address 2
City
*
State
*
- Select -
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Himachal Pradesh
Haryana
Jharkhand
Jammu & Kashmir
Karnataka
Kerala
Maharashtra
Manipur
Meghalaya
Madhya Pradesh
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
--
Andaman & Nicobar
Chandigarh
Dadra & Nagar Haveli
Daman & Diu
Delhi
Lakshadweep
Puducherry
PIN code
*
Member 2
Member 2 Mobile Number
Member 2 Blood Group
- None -
A+
A-
B+
B-
AB+
AB-
O+
O-
Member 2 Blood Donation Freq
- None -
3 Months
5 Months
6 Months
7 Months
9 Months
Yearly
Member 2 Last Blood Donation Date
Date
E.g., 2022/06/23
Member 3
Member 3 Mobile Number
Member 3 Blood Group
- None -
A+
A-
B+
B-
AB+
AB-
O+
O-
Member 3 Blood Donation Freq
- None -
3 Months
5 Months
6 Months
7 Months
9 Months
Yearly
Member 3 Last Blood Donation Date
Date
E.g., 2022/06/23
Member 4
Member 4 Mobile Number
Member 4 Blood Group
- None -
A+
A-
B+
B-
AB+
AB-
O+
O-
Member 4 Blood Donation Freq
- None -
3 Months
5 Months
6 Months
7 Months
9 Months
Yearly
Member 4 Last Blood Donation Date
Date
E.g., 2022/06/23
Member 5
Member 5 Mobile Number
Member 5 Blood Group
- None -
A+
A-
B+
B-
AB+
AB-
O+
O-
Member 5 Blood Donation Freq
- None -
3 Months
5 Months
6 Months
7 Months
8 Months
Yearly
Member 5 Last Blood Donation Date
Date
E.g., 2022/06/23
Member 6
Member 6 Mobile Number
Member 6 Blood Group
- None -
A+
A-
B+
B-
AB+
AB-
O+
O-
Member 6 Blood Donation Freq
- None -
3 Months
5 Months
6 Months
7 Months
9 Months
Yearly
Member 6 Last Blood Donation Date
Date
E.g., 2022/06/23
Subscription
*
- Select a value -
General - Rs. 900
Address Proof
*
- Select a value -
Aadhar card
Electricity bill
Voter Id
Telephone bill
Water bill
Ration card
Passport
License
Soft copy of offline payment receipt
Please upload soft copy of offline payment receipt if you made payment through bank.
Files must be less than
8 MB
.
Allowed file types:
png gif jpg jpeg
.
Self Declaration
*
I declare that I am an Indian, Jain residing at the address mentioned in my application form. I further declare that the mentioned facts are true and correct to the best of my knowledge and does not have any false declaration. And if it is found incorrect, I authorize JRF to cancel my membership without any liabilities. I accept all the rules and regulations of JRF from time to time related to the society.