Associate Registration Form

Please fill in your details carefully. Once your payment is confirmed, our admin team will review your application and activate your associateship.

Associate Application Form

All fields marked * are required

How it works: Fill in your details → Upload the required documents → Scan the QR code and make the payment → Submit your application. Our admin team will review it after payment confirmation.

Personal Details

Applicant Name *

Aadhar Number

Applied State *

Applied District *

Experience

Mobile Number *

Email Address

Date of Birth

Father's Name

Mother's Name

Category

Blood Group

Address Details

Permanent Address

State

District

Pin Code

Current Address

Qualification & Programme

Qualification *

Join Associate As *

Our Programme *

Document Upload

Final Educational / Company Documents * JPG / PNG / PDF, max 5MB

Passport Size Photo * JPG / PNG, max 2MB

Signature * JPG / PNG, max 1MB

Payment

Scan the QR code above using any UPI app, complete the payment, then fill in the details below.

Payment Transaction No. *

Payment Date *

Upload Payment Slip / Screenshot * JPG / PNG / PDF, max 5MB

I agree to the Terms & Conditions of the organization and confirm that all details provided are true and accurate.

Associate Registration Form

Associate Application Form

Application Submitted Successfully!

Swachh Evam Swasthya Jagrukta Mission