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