NATIONAL HUMAN RIGHTS COUNCIL Regn. No. IV – 07101/14 Govt. of India Regd. Office : Durganagar, Station Road (Madhya), 2nd Bye Lane, Jadu Bhatta Sarani P.O. – Rabindranagar, P.S. - Nimta, Kolkata – 700065, W.B., India Ph. : 033-6451-2931, Email : [email protected], Website : www.nhrcouncil.com MEMBERSHIP APPLICATION FORM Membership No. : NHRC/ Affix a recent Passport size photograph To, The Chairman (India) National Human Rights Council I Mr./Mrs./Miss/Dr. (In block letters): ......................................................................................................... Son/Daughter/Wife/Husband of. ................................................................................................................ Address: ............................................................................................................................................................. Post Office : ............................................................... Police Station : ............................................................... Dist. .......................................................... State ............................................... Pin .......................................... Date of Birth: ............................................... Sex: ...... M/F Nationality: .................................................... Education: ............................................................................ Occupation: .................................................... Contact No.: ............................................... E-Mail : ....................................................................................... Details of Bank Draft/Cheque ........................................................................................................................ Do hereby apply for membership of your organization. l I am willing to work on voluntary basis for protection of democratic Human Rights and Consumers Rights of the people under the guidance of your organization. I sincerely declare that there is no illegal offence is pending against me in any of the courts. l I solemnly declare that I shall sincerely work to implement the principals laid down in the Universal declaration of Human Rights adopted in 1948 at UNO. I shall fight for the sufferers and deprived people and also against all sorts of operation, victimization and unlawful treatment. l I hereby sign the membership form and shall abide by the rules and regulations of the organization now in force and/or may change from time to time. Yours truly Designation: ...................................................... (Signature of the Applicant) ............................................................................ Introduced By Date: Place: Chairperson's Signature Terms & Conditions: ? Cheque/DD should be issued in favour of – "NATIONAL HUMAN RIGHTS COUNCIL". The Governing body reserves the right to expel any Member/Post holder of the organization without assigning any reason whatsoever and the so called member is liable to submit his/her ID card including relevant papers within 15 days of his/her expulsion otherwise strict action will be taken against him/her. Member/ office bearer, if found guilty is liable to be sacked by the authorities concerned and strict legal action would be taken against him/her. Date of Issue:....................................................... Date of Renewal: .............................................. OATHS/ACCEPTANCE/DECLARATION To The Chairman (India) NATIONAL HUMAN RIGHTS COUNCIL Regd. Office : Durganagar, Station Road (Madhya), 2nd Bye Lane, Jadu Bhatta Sarani, P.O. – Rabindranagar, P.S. -Nimta, Kolkata – 700065, W.B., India Ph. : 033-6451-2931 : Email : [email protected], Website : www.nhrcouncil.com Dear Sir, I, Mr./Mrs./Miss ................................................................................................................................................... S/D/W of ................................................................................................................................................................ Residence of ............................................................................................................................................................ .................................................................................................................................................................................. Solemnly take oaths/accepted and declared that ? I am joining and subscribing NATIONAL HUMAN RIGHTS COUNCIL (NHRC) with my own consent without any force or pressure from anybody from NHRC or from outsider. ? I will serve the National Human Rights Council, People & Society absolutely on the basis as volunteers for which I will not claim any kind of payments or service charges or any kind of expenses. ? I will be fully dedicated to Human rights, Liberties and Social Justice, Social Work for masses and not for individual or my benefits. ? I will not misuse the name of National Human Rights Council for my own sake and benefits — Strictly, if found liable to face action by DISCIPLINE ACTION COMMITTEE OR CHAIRPERSON which is final. ? I will pay my entire Membership Donation, Contribution, subscription in time and with my own acceptance, consent and agreement, ? I will obey the code of conduct of the National Human Rights Council in all mode and all time. ? I will not be involved with any kind of illegal activities , functions, seminars , rally which against the law of India and Constitution , society. ? That National Human Rights Council will not be held responsible at all for my involvement with any kind of illegal activities, business and court cases which is against the law of India, Constitution and society. ? I have never been involved /indulged with any kind of human rights violation and never-been convicted by the court for the same, my membership can be withdrawn immediately, if found guilty with anything violated the law of India Constitution or society or the code of conduct of the society and accepted the final decision of the DISCIPLINE ACTION COMMITTEE OR CHAIRPERSON. ? I also authorize National Human Rights Council to put my name on the website of NHRC ? I will the serve the National Human Rights Council with whatever responsibility and accountability given to me. ? I understand that, my Membership is non-transferable and once the payment is made, it is non-refundable. ? Any kind of misbehavior or misconduct may result in rejection of membership of National Human Rights Council. All disputes subject, to jurisdiction of Kolkata only. That National Human Rights Council will not be responsible for any misuse of Identity Card, Certificate, Car Sticker, Letter Head, Stamp issued to me during the course of my Membership with National Human Rights Council. ? That On expiry of validity, I will submit my Identity Cards and all papers to the National Human Rights Council Office. After expiry, In case of change of address, I will inform the same to the NHRC Office. ? That in case of loss of the Identity Card, I will inform the NHRC Office in writing along with the F.I.R. immediately. ? That I am ready to face strict action, if found guilty floating the rules and regulations of National Human Rights Council, and are also punishable under Bye-Laws. ? That if I am holding the ID card, I will serve the people absolutely free and voluntarily and provide free advice time to time. ? If I have any doubt, question or problem, will contact National Human Rights Council office with the All rights reserved to National Human Rights Council. DECLARATION: 1. I hereby solemnly affirm and declare that the particulars mentioned by me here in above are true & correct to the best of my knowledge and belief and nothing has been concealed or suppressed thereof. If anything found incorrect at any stage, my membership/post may be terminated. 2. I honestly declare that I will not involve myself directly or indirectly in any act which will be against the prestige of our Nation, Society, and National Human Rights Council as well. 3. I will abide by the rules and regulations and Bye-laws of the National Human Rights Council in force from time to time. Signature (Member only): Signature (Reference only): Name........................................................................ Name............................................................................ Mobile No. .............................................................. Mobile No. .................................................................. Date Date Place Place
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