Adya Education and Charitable Trust

1. Basic Information

Name of the Centre/Institution *

Please enter the name of the centre/institution.

Registered Name (if different)

Full Address *

Please enter the full address.

City *

Please enter the city.

District *

Please enter the district.

State *

Please enter the state.

PIN Code *

Please enter a valid 6-digit PIN code.

Year of Establishment *

Please enter a valid year.

Registration Number (if any)

Affiliated with any University/Agency

Website (if any)

Type of Institution *

Please select the institution type.

Number of Enrolled Students

Number of Staff Members

Membership Type *

Please select the membership type.

2. Contact Details

Name of the Centre Head / Owner *

Please enter the name of the centre head.

Mobile Number *

Please enter a valid 10-digit mobile number.

Alternate Contact Number

Please enter a valid 10-digit contact number.

Email Address *

Please enter a valid email address.

3. Payment Details

Payment Mode *

Please select the payment mode.

Transaction/Reference ID

Payment Date

Amount Paid (₹) *

Please enter the amount paid.

4. Document Uploads (Max 2MB per file, PDF/JPEG/PNG only)

Aadhar Card *

Upload a clear copy of your Aadhar card (Front side only)

Please upload a valid Aadhar card (PDF, JPG, or PNG, max 2MB)

PAN Card *

Upload a clear copy of your PAN card

Please upload a valid PAN card (PDF, JPG, or PNG, max 2MB)

Passport Size Photo *

Upload a recent passport size photo (JPG/PNG, max 2MB)

Please upload a valid passport photo (JPG or PNG, max 2MB)

Signature *

Upload your signature (JPG/PNG, max 2MB)

Please upload a valid signature image (JPG or PNG, max 2MB)

Additional Documents (Optional)

Registration Certificate

Upload registration certificate if available (PDF, JPG, or PNG, max 2MB)

All documents will be securely stored and only used for verification purposes. Please ensure all uploaded documents are clear and legible.

I hereby declare that all the information provided above is true and correct to the best of my knowledge. I understand that any false information may lead to rejection of my application.

You must agree to the declaration to proceed.

Membership Application Form

1. Basic Information

2. Contact Details

3. Payment Details

4. Document Uploads (Max 2MB per file, PDF/JPEG/PNG only)

Additional Documents (Optional)