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ALL INDIA CRICKET ASSOCIATION FOR THE PHYSICALLY CHALLENGED

(FOUNDED BY THE LATE SHRI.AJIT WADEKAR)

c/o Fellowship of the Physically Handicapped, FPH Building, Lala Lajpat Rai Marg, Haji Ali, Mumbai – 400034.
+91 22 249 38476
REGISTERED UNDER SEC-80(G)

PERSONAL DETAILS
First Name
Middle Name
Last Name
Address Line 1
Address Line 2
State
City
Pincode
Telephone
Mobile No
Email Address
Emergency Contact
Relationship
Emergency Contact No
Birth Date
MARITAL STATUS
Marital Status
Total Kids
NATURE OF HANDICAP
Percentage
Temporary
Permanent
AID Taken
Blood Group
EDUCATION QUALIFICATIONS
Qualification
OCCUPATION
Employment Type
Employers Address
CRICKETING ABILITIES
Fielding Position
ACHIEVEMENTS
MEMBER OF OTHER ASSOCIATIONS
Name / Address
DOCUMENTS
Handicap Certificate
Upload Handicap Certificate
Railway Concession Certificate
Upload Railway Concession Certificate
S.T. Concession Certificate
Upload S.T. Concession Certificate
Driving License
Upload Driving License
Passport
Upload Passport
Photo ID
Upload Photo ID
Address Proof
Upload Address Proof
Bank Details
Upload Banking Proof
Birth Date Proof
Upload Birth Date Proof
DRESS MEASUREMENT
Collar / Shoulder
Waist
Lower (Length / Hip)

(AICAPC RESERVES THE RIGHT TO ACCEPT/REJECT THE MEMBERSHIP FORM)