New Hope – Contributor / Voluntary Staff Member Form (Individual)

Name of the Applicant

Sex
Male Female Others

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Father/Husband Name

Date of Birth

Age

Blood Group

Name of Denomination

Name of Church / Mission

Applicant's Address

Pin code

Mobile No

E mail

Mother Tongue

other Languages You Know

Educational Qualification : (Secular)

Theological Education

Missionary Training if any

Years of Experience in Ministry

Date of Ordination in Ministry

Ordination in Ministry

Your Present position in your organization

Name of Organization that ordained you

Name of mission Field you Work

District

State

Nation

Nearest Railway station from your mission Field

Distance from the nearest Railway station to your field

Nearest Town / city from your Mission field

Number of families in your church

Church has

Church building Roof

Church is Registered under

Monthly Income of your Church is Rs (Approximately)

Name of the Organization that supports you Financially

Monthly Support or salary you receive

Yes No

If Yes Rs

Are you Ministering as

Are you working in any : Government / Private / Own Business

Yes No

If you are working (in any Government / Private job) your salary / month

Family Details : (Attach a family Photo, if Possible)

Name	Relationship	Date of birth	Age	Occupation

Have you ever divorced

Yes No

If yes year of divorce

Do you have any sickness like : Cancer / Heart ailments / Any other ?

Are you a physically challenged

Yes No

If yes state

Is any one in your Family Working as staff in New hope

Yes No

If yes Name and address

Are you willing to join in New Hope Project on personal willingness?

Yes No

Will you contribute annually and regularly?

Yes No

Your Bank Details : ( Nationalized Bank )

Bank Name

Bank Branch Name

(Branch Code)

Bank Branch IFS code No

Your Account No

Your Account is : Saving / Current / NRI

Your Nominee’s Name

Nominee’s Relationship to You

Nominee’s Account Number if any

Bank Name

Place

IFS code

Address Proof (Attach a copy). Aadhaar / Ration card / Voter ID / any other

Declaration

I, hereby Declare that all information that I have given above are true to the best of my knowledge and I would agree all the terms and conditions that are now and will be made every now and then in future for the better service of New Hope Project. I also agree to settle the matters if any within the judicial jurisdiction at Nagercoil.

Place

(Applicant’s Signature)

Date

Introduced / Recommended by :

New Membership contribution Rs

Paid on

If paid by DD/Cheque No

Date

For Official use only

Accepted / Rejected

Membership No : CM

Receipt No

Date

Verified by