Masonic Ark Foundation (Regd.94/2019)

Freemasons Fraternity Family Benefit Scheme

SCHEME APPLICATION FORM

Masonic Details

Please submit and print this form, only if the data below is correct. In case of errors, please contact the RG Secretariat to update the data

Name of the Member (with Masonic title)

RGLSI ID

Applicant Data

Name of the Applicant

(as on PAN Card / Aadhar Card)

Date of Birth

Age (on date of application)

Father's Name

PAN Card No.

Aadhar Card No.

Permanent Address

 

City :

State :

PIN :

Mobile

email id

Upload Documents

PAN Card

Aadhar Card