Apply — Nepal Pahari Development Association

1

Personal Details

Full Name (in Nepali) *

Full Name *

Date of Birth (B.S.) *

Date of Birth (A.D.)

Filling either one converts the other.

Citizenship No. *

Issuing District *

Photo *Choose a filePassport size · max 4 MB

Gender *

FemaleMaleOthers

2

Permanent Address

District *

Municipality / RM *

Ward *

Tole

Please also write the municipality name in English. The district goes onto your card in English automatically.

Municipality / RM in English

Tole in English

3

Temporary / Current Address

District

Municipality / RM

Ward

Tole

Municipality / RM in English

Tole in English

4

Family Background

Grandfather's Name

Father's Name *

Father's Citizenship No.

Mother's Name *

Mother's Citizenship No.

Spouse's Name

5

Education, Profession

Academic Qualification

Current Occupation

6

Contact & Social Media

Mobile No. *

WhatsApp No.

Email

Facebook ID

Instagram ID

Emergency Contact & Relation

Phone

7

Type of Membership

General MemberLife MemberCommitted MemberPatron Member

8

For Existing Members Only

Have you previously taken a membership of this Pahari Association?

YesNo

Previously a Member Since (B.S.)

Old Membership Number

9

Declaration

I express my commitment to fully abide by the constitution, rules and objectives of the Nepal Pahari Development Association. All details given above are true and correct; should any be found false, I am prepared to face action as per prevailing law.

I have read and accept the declaration above. *

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