Swatantra

Name*

Name of Father/Spouse/Guardian

Gender Male Female Other

DOB

AGE

Email

Mobile Number

Nationality

Domicile in India

State

District

Constituency: Assembly/Parliament :

Ward No

Zone No

Panchayat/Town Panchayat/Township/Municipality/Corporation

Block

Taluk

Adhaar Card No

Pan Card No

Address

City/Village

Pin Code

Voter ID number

Photo

Please upload individual photo.

DECLARATION

I hereby declare that the above information furnished by me are true to my knowldge and I shall abide by the rules and regualtions of Swatantra Party(Jan).I am aware that they reserve the right either to accept or reject my application form for free membership without assigning any reason

Signature

Please upload Signature.

Application Number(Offline)Office Use Only

Registration Form