Award Nomination Form

Nomination for Award Category* :

Name* :

Gender* :

Mother Name* :

Father/Husband Name* :

Date of Birth* :

Education Qualification*:

State* :

District*:

Mobile No. (+91)*:

WhatsApp No. (+91)*:

Permanent Address*:

Correspondence Address*:

Pin Code*:

Email:

PAN No.*:

Aadhar No.*:

Language Known*:

Hindi

English

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Urdu

Tamil

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Passport Size Photo*:

Achievement & Experience (PDF & Image)*:

Aadhar Card Front*:

Aadhar Card Back*:

I hereby declare that I have carefully understood the requisite norms of good conduct, I will fully adhere to the said conduct. In the event of violation of rules by me under any circumstances, Swarnim Himachal Jan Jagran Smiti, Himachal Pradesh is free to take any disciplinary action against me, in accordance with the rules as prescribed by the Swarnim Himachal Jan Jagran Smiti, Himachal Pradesh.

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