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Namo Tassa Bhagavato Arahato Sammasambuddhassa

1. Name *

2. Academic Qualification

3. Designation

4. Full Address

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Contact No *

5. Email *

PAN No

Aadhar No

Candidate Signature *

7. Recommended by (Founder Member of PSI)

8. Cheque / Date / Amount / Bank & Branch

Development Fee: ₹100/-
Membership Fee: ₹3,000/-

Date

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