WJI

WJI Membership Form

Working Journalists of India

Name *

First

Middle

Last

Aadhaar Card No.

Date of Birth *

Marital Status

Father's/Husband's Name *

First

Last

Nsmr of Nominee *

First

Last

Relation with Nominee *

Nominee's Mobile No. *

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact No. *

Landline STD

Email *

Name of your Organization *

Designation *

Nature of Work *

Working Language *

Specialization *

Experience *

Academic Qualification *

Professional *

Whether accredited with PIB/State Govt./Others *

I apply for the Registration for WJI. I do hereby declare that no criminal case is pending against me in any court or police station. I am a working journalist as defined in the Working Journalist Act. I am not a member of any journalist union. If yes, please give the name of the union..............Since.(input Details in above box)

Message

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