Membership Application | Nepal Jana Samparka Samiti Australia

1

Membership Details

Membership Category*

Kriyasil Sadasya (Active Member)Jana Samparka Sadasya (General Member)

Application Type*

New ApplicationMembership Renewal

2

Personal Information

Full Name (English)*

Full Name (Nepali)

Gender*

MaleFemaleOtherPrefer not to say

Date of Birth*

Country of Birth

Citizenship Status*

Nepali CitizenAustralian CitizenPermanent ResidentOther

Occupation / Profession

District of Origin (Nepal)*

Municipality / Rural Municipality

Ward Number

3

Contact Details

4

Social Media Details

Facebook Profile Link

Instagram Profile Link

LinkedIn Profile Link

Organisational Affiliation

Have you previously been a member of Nepali Congress or Nepal Jana Samparka Samiti?*

YesNo

Are you currently associated with any Nepali community organisation in Australia?

YesNo

Additional Information

Areas of Interest (Select all that apply)

Community ServiceYouth AffairsWomen's AffairsCultural ActivitiesSportsMedia & CommunicationInformation TechnologyEducationPolicy & ResearchOther

6

Document Uploads

Bank Transfer Details

BSB:067873

Account Number:19120460

Reference:Your Full Name + MEMBERSHIP

Passport-Size Photograph*

Recent passport-size photo (JPG or PNG)

Click to upload

JPG, PNG, PDF up to 5MB

Proof of Identity*

Passport, Driver Licence, Citizenship Certificate or other Government-issued ID

Click to upload

JPG, PNG, PDF up to 5MB

सदस्यता शुल्क

🔹 क्रियाशील तथा जनसम्पर्क सदस्यता नवीकरण शुल्क: AUD $40
🔹 नयाँ जनसम्पर्क तथा क्रियाशील सदस्यता आवेदन शुल्क: AUD $70

Proof of Payment*

Please take a photo of the payment receipt and upload it in the box below.

Click to upload

JPG, PNG, PDF up to 5MB

7

Declaration

I hereby declare that the information provided in this application is true and correct to the best of my knowledge. I agree to abide by the Constitution, Rules, Regulations, Principles, and Decisions of Nepal Jana Samparka Samiti Australia and uphold the democratic values and ideals associated with Nepali Congress.

I Agree to the above declaration*

8

Electronic Signature

Applicant's Full Name (Electronic Signature)*

Date*