ADVISORY BOARD MEMBER

APPLICATION FOR ADVISORY COMMITTEE

Please complete and submit this questionnaire as part of the application and selection process for the Advisory Committee. Saigram Charitable Trust will use this information to perform a background check, conduct a conflict of interest review, and perform other similar due diligence activities associated with your application and possible selection as a representative on the Advisory Committee. Saigram Charitable Trust will use the information you provide only for these purposes or other purposes authorized by law, or as outlined under the attached Privacy Act Statement. Please ensure that the information you provide is complete and accurate.

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Last Name First Name Middle Name
Aadhaar Number E- Mail Address Current Profession
Position/Title Nationality Office Number
Mobile No Other Phone Date of Birth
Place of Birth Age Sex
Mother Tongue Blood Group Languages Known
Family Members Section
Family Members Name Age
Relationship Blood Group
Address Á Contact Details
PRESENT RESIDENTIAL ADDRESS
PERMANENT ADDRESS
In Case of Emergency Contact
Contact Person Name Mobile No Phone Number
List education and any specialized experience not listed on your resume
DECLERATION
I hereby agree to abide by the rules and regulations of SAIGRAM CHARITABLE TRUST (REGD. which are in force and which will be amended from time to time. I certify that the statements I have made on this form are true, complete, and correct to the best of my knowledge.

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