Supansha® Development Foundation

1. SURMAI Welfare Groups

Select the category under which you want to join or associate.

Application Category *

2. Applicant Information

First Name *

Middle Name

Last Name *

Date of Birth *

Age

Gender *

Highest Qualification *

Occupation *

Person with Disability (PwD)? *

Disability Category

Associate Category *

Business / Service Provider Name *

Business / Entity Type *

Establishment / Start Date *

Business / Service Age

Contact Person *

Designation / Role *

Offer Details

Offer Type *

Specific Product / Service Offered *

Discount Offered *

Offer Validity *

Select the specific product or service, the discount offered to SURMAI Welfare Card Holders, and the validity of the offer.

3. Contact & Location

Mobile Number *

WhatsApp Number

Email Address *

Country *

State / Province *

District / City *

Town / Village *

PIN Code *

4. Purpose / Interest

Purpose / Reason for Joining or Associating *

Brief Introduction / Purpose *

5. Declaration, Security & Consent

Security Check *

SURMAI Welfare Groups