Membership Form Your name Photo: Date Of Birth : Number of Roll in Orissa State Bar Council (With Date): Bar Council Welfare Fund No: Are You a Member of Pension Fund of Bar Council: YESNO If Yes , SL NO: Name of Your Father: Occuaption: Name of Your Wife/Husband: Occuaption: Your Permanent Address: Mobile Number: Email: Blood Group: Whether You are Member of any Other Bar Association ?(Name it): Social Activities (If Any): Any Other Useful Information you would like to note here : Present Place of Practice: Recommendation by Two Members of This Bar Association: 1.Name of The Identifying Member: Enrollment Number: Full Signature: Name of the Identifying Member: Enrollment Number: Full Signature: Education/Professional/Any Other Qualification: Matriculation: Graduation: Law Degree: Post Graduation: Name(s) of Your son(s) & daughter(s): Date Date