MEMBERSHIP APPLICATION FORM
(Fields marked as * are mandatory)
Email Id
*
Send OTP
OTP
*
Verify OTP
P.F. No.
*
Name of the Pensioner/ Retiree/ Family Pensioner
*
Family Pensioner
*
Select Please
YES
NO
Name of Deceased Spouse
*
Date of Death
*
Mobile Number
*
Landline Number
Date of Birth
*
Blood Group
Select Please
A+
A-
B+
B-
AB+
AB-
O+
O-
Date of Retirement
*
Retired from
*
Select Please
Union Bank of India (UBI)
Corporation Bank (COR)
Andhra Bank (AND)
Pension Payment Order No.
PPO Date
Last Place of Posting
*
Last Designation
*
Nature of Cessation
*
Select Please
Superannuation (SUP)
Voluntary Retirement under OSR (VOL-OSR)
Voluntary Retirement under 2000-2001 Resignation Scheme (VOL-RES)
Are you a Member of UBIREMAS
*
Select Please
YES
NO
Name of Spouse/ Next of Kin
*
Relation with the Applicant
*
Select Please
Spouse
Son
Daughter
Others
Contact No. of Spouse/ Next of kin
*
Present Location/ City
*
Residential Address
*
Pin Code
*