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SWG MEMBERSHIP
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Apply For
SWG Membership
1. SURMAI Welfare Groups
Select the category under which you want to join or associate.
Application Category
*
Select Category
SURMAI Sakhi
SURMAI Mitra
SURMAI Associate
SURMAI Donor
2. Applicant Information
First Name
*
Middle Name
Last Name
*
Date of Birth
*
Age
Gender
*
Select Gender
Female
Male
Third Gender
Highest Qualification
*
Select Highest Qualification
Class 10 / Secondary
Class 12 / Higher Secondary
Certificate Course
Diploma
ITI / Vocational
Undergraduate
Graduate (Bachelor's Degree)
Postgraduate (Master's Degree)
Professional Qualification
Doctorate / PhD
Other
Occupation
*
Select Occupation
Banking / Finance Professional
Business / Self-Employed
Education / Teaching Professional
Farmer / Agriculture
Government / Public Sector Service
Healthcare / Medical Professional
Homemaker
Private Sector / Corporate Service
Professional / Consultant / Legal
Retired
Student
Unemployed / Seeking Work
Other
Person with Disability (PwD)?
*
No
Yes
Disability Category
Not Applicable
Associate Category
*
Select Category
Beauty, Spa & Personal Care Services
Business & Retail Supplies
Computer, IT & Digital Services
Education & Training Services
Healthcare, Medical & Emergency Services
Hotels & Restaurant Services
Professional & Legal Services
Social, Community & Other Services
Tours, Travel & Transport Services
Other
Business / Service Provider Name
*
Business / Entity Type
*
Select Type
Company
Institution
LLP
Partnership
Professional Practice
Proprietorship
Society / Trust / Foundation
Other
Establishment / Start Date
*
Business / Service Age
Contact Person
*
Designation / Role
*
Offer Details
Offer Type
*
Select Offer Type
Product
Product & Service
Service
Specific Product / Service Offered
*
Select Product / Service
Discount Offered
*
Select Discount
Free
Offer Validity
*
Select Offer Duration
1 Year – Fixed Term of MoU
3 Years – Fixed Term of MoU
5 Years – Fixed Term of MoU
Lifetime
Limited Time Offer
Select the specific product or service, the discount offered to SURMAI Welfare Card Holders, and the validity of the offer.
Other Product / Service Details
*
Offer Start Date
*
Offer End Date
*
Donor Type
*
Select Donor Type
Company / Business
Government
Individual / Philanthropist
Organisation / Institution
Other Supporter
First Name
*
Last Name
*
Date of Birth
*
Age
Organisation / Entity Name
*
Establishment Date / Foundation Day
*
Entity Age
Entity Type
*
Select Entity Type
Association
College
Company
Educational Institution
Foundation
Government
Hospital / Healthcare
NGO
School
SHG
Social Enterprise / Business
Society
Trust
Other
Contact Person
*
Designation / Role
*
Support Type
*
Select Support Type
Financial
Financial & In-kind
In-kind
3. Contact & Location
Mobile Number
*
WhatsApp Number
Email Address
*
Country
*
India
Other
State / Province
*
Select State / Province
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Andaman and Nicobar Islands
Chandigarh
Dadra and Nagar Haveli and Daman and Diu
Delhi
Jammu and Kashmir
Ladakh
Lakshadweep
Puducherry
Other
District / City
*
Town / Village
*
PIN Code
*
4. Purpose / Interest
Purpose / Reason for Joining or Associating
*
Select Purpose / Reason
Access to SURMAI Welfare Benefits
Community Participation & Welfare
Learning & Capacity Building
Offer Discounted Products / Services
Partnership / Collaboration
Philanthropic / Donor Support
Social Action / Volunteering
Support Social Causes
Other
Brief Introduction / Purpose
*
5. Declaration, Security & Consent
Security Check
*
Refresh
I confirm that I am 18 years of age or above, and that the information provided by me is true and correct to the best of my knowledge. I agree to the processing of my application by Supansha Development Foundation.
I agree to receive application-related communications, verification messages, regular updates, Quarterly Bulletins, Yearly Reports and other relevant communications from Supansha Development Foundation through Email, WhatsApp and SMS.
I understand that submission of this form does not mean acceptance or approval of my application. Final approval is subject to the decision of the authorised authorities of Supansha Development Foundation.
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