FBS Membership Registration Form

APPLICATION FORM FOR FBS MEMBERSHIP

Fill all details in CAPITAL LETTERS as per guidelines.

1. Applicant Personal & Membership Details

Central IAP Membership No. *

Full Name (as per IAP Records) *

Educational Qualification *

Date of Birth *

Gender *

Local IAP Branch Resided *

Mobile Number *

Email Address *

PAN Card Number *

Aadhaar Number *

State *

Pincode *

Full Postal Address *

Applicant Passport Photo *

Proof of Age Document *

PAN Card Copy *

Aadhaar Card Copy *

2. Nominee Details (1 to 3 Nominees - Shares must total 100%)

Nominee 1 *

Nominee Full Name *

Relationship *

Postal Address *

Date of Birth *

Share (%) *

Mobile Number *

PAN Number *

Aadhaar Number *

Photo *

Aadhaar Copy *

PAN Card Copy *

Nominee 2 (If Applicable, all fields are mandatory)

Nominee Full Name

Relationship

Postal Address

Date of Birth

Share (%)

Mobile Number

PAN Number

Aadhaar Number

Photo

Aadhaar Copy

PAN Card Copy

Nominee 3 (If Applicable, all fields are mandatory)

Nominee Full Name

Relationship

Postal Address

Date of Birth

Share (%)

Mobile Number

PAN Number

Aadhaar Number

Photo

Aadhaar Copy

PAN Card Copy

3. Fee Calculation & Bank Payment Details

Bank Details for Direct Payment / Transfer

Account Name:	FAMILY BENEFIT SOCIETY
Bank Name:	KOTAK MAHINDRA BANK
Branch:	SOMAJIGUDA BRANCH, HYDERABAD - 500082
Savings A/C No:	1811659272
IFSC Code:	KKBK0000552

Scan with BHIM / Any UPI App

Auto-Calculated Fee Breakdown (Based on Date of Birth): Select Date of Birth above to calculate total payable amount.

Payment Mode *

Cheque / DD / UTR Ref No. *

Payment Date *

Bank Name & Branch *

4. Health Declaration

I hereby declare that I am NOT suffering from any critical/terminal illness or life-threatening ailment as of today.

- Important:

1. After submitting this form, you will be directed to a page from which you must download and print the submitted application. Please affix the required thumb impressions, wherever applicable, attach all necessary supporting documents, and submit the duly completed and signed printout along with the required hard-copy documents to the IAP FBS Office.

2. Following verification of the submitted documents, the FBS IAP Office will contact you regarding the next steps.