Delhi State Rifle Association

B-211 (Basement) Phase No.1, Okhla, New Delhi-110020 Mob No. 9811461320-9810582228
Email: [email protected]; [email protected]| Web: www.dsra.in

MEMBERSHIP FORM

Instructions for filling up the form

1. The form should be filled in MS-Word and then printed and signed.After download, press ESC key
when the file opens in Word, for enabling keyboard input. Sign on all pages at the bottom.
2. All the columns should be answered. If a question does not apply to you then please mention N/A.
3. In case of students, the School/ College name and address should be mentioned in the office address.
4. In case of Minors (below 18 years) the Form should be counter signed by parents of the applicant.
5. Cheque/Draft should be made in favour of Delhi State Rifle Association.Cheques should be from the
applicant’s own account and his/her name should be printed on the cheque leaf.
6. Attested photocopy of proof of address and age has to be submitted.
7. Passport/Voter I Card/Arms License will be accepted as proof of residence. In case of Minors either Passport or
a letter containing an attested photograph of the applicant from the educational institution of which he/she is a
student will be accepted as address proof.
8. In case of Junior Membership an attested copy of Municipal Birth Certificate has to be attached. In addition, as
and when required, the result/ report of medical verification of age from a designated Testing Centre has to be
provided in accordance with the DSRA’s Age Fraud Circular.
9. Copy of Arms License should be submitted if the applicant holds an Arms License.
10. Copy of Membership card should be attached in case the applicant is a member of NRAI or any other State
Shooting Body/Association or any club. If applicable, copy of Shooter’s ID issued by NRAI should be attached.
11. Copy of F.I.R should be attached in case the applicant is involved in any criminal case/act.
12. Medical Fitness Certificate is compulsory for all categories of membership by MBBS Doctor only .

The details of various Categories of Membership and the Membership Fee is as under.
Life Membership - This membership is valid for lifetime with the fee paid at the time of joining. This
membership is available for Rs. 35,400/- (30,000/- + 18% GST).
Annual Membership- This membership is valid initially for 5 years after which, it can be renewed annually by
paying the annual subscription. Membership fee is Rs23,600/- (20,000 + 18% GST) plus
Rs5,900/- (5,000 + 18% GST)towards annual subscription for the next five years. Annual
subscription is Rs 1,180/- per annum (1000 + 18% GST).
Junior Membership- This membership is for applicants below the age of 21 years. This membership shall remain
valid till the age of 21 years. Membership fee is Rs 5,900/- (5,000 + 18% GST).
Foreign National Membership- This membership is for foreign nationals and this membership valid for lifetime.
Membership Fee is Rs59,000/- (50,000/- + 18% GST).
Associate Membership- This membership is for Armed Forces / Services personnel who are on temporary posting in
Delhi. Membership fee isRs. 17,700/- (15,000/- + 18% GST).
Non-Resident Annual Membership- This category is for those who are not permanent residents of Delhi. This
membership is available for Rs 17,700/- (15,000/- + 18% GST)plus Rs 5,900/- (5,000 + 18%
GST)towards annual subscription for the next five years @ Rs 1000/- per annum.
Affiliated/Institutional Membership- This membership is for Institutions and Clubs who wish to promote shooting sport
in Delhi. Membership fee is Rs 17,700/- (15,000/- + 18% GST)plus Rs2,360/- (2000 + 18%
GST) towards annual subscription every year subsequently.
EWS Category Membership- This membership is for Economically Weaker Sections (EWS) of society. Membership fee
is Rs. 119.18/- (101/- + 18% GST). This membership is valid for one year; which can be
renewed every year on payment of Re. 1/- as renewal fee. The renewal is subject to approval
of Governing Body.
Representative Membership- This membership is for the people who wish to represent Delhi State in all shooting
competitions organized by National Rifle Association of India. Membership fee is Rs
17,700/- (15,000/- + 18% GST) and is valid for lifetime.
Note:A discount of 25% is available for blood relatives and spouses of existing DSRA members.

Applicant’s Signature ________________________________

 Delhi State Rifle Association
B-211 (Basement) Phase No.1, Okhla, New Delhi-110020 Mob No. 9811461320-9810582228
Email: [email protected]; [email protected]. Web: www.dsra.in

FOR OFFICE USE ONLY Affix one

passport size
Receipt No. ________________ Date: ___________ Amount: ________________
photograph
Category: ______________ Membership No. ___________ Validity: ____________

Category of Membership Click here to enter text.

applied for (in CAPITALS)
Membership Fee Cheque Click here to enter text. Drawn on Click here to enter text.
No. and Date
NAME OF APPLICANT ARYAN SAXENA

If known by any other Click here to enter text.

name
Date of Birth (dd-mm-yy) 07-02-2002 Male / Female MALE
Place of Birth DELHI Nationality INDIAN
Blood Group (if known) O+ Marital Status UNMARRIED
Name of Father LT. ANUJ SAXENA Occupation Click here to enter text.
Name of Mother SHWETA SAXENA Occupation TEXTILE DESIGNER
Name of Spouse
Click here to enter text. Occupation Click here to enter text.
(if married)
FLAT A-203, ISHWAR APPARTMENTS, DWARKA SECTOR-12, PLOT-4
Present Address
NEW DELHI-110078
FLAT A-203, ISHWAR APPARTMENTS, DWARKA SECTOR-12, PLOT-4
Permanent Address
NEW DELHI-110078
Phone No. (Mobile) 8512868415 Phone (Res.) 9310290829
Email ID [email protected]
Occupation of Applicant STUDENT
Click here to enter text.
Brief Description of your
work Click here to enter text.
Office Address and Click here to enter text.
Phone
Residing in Delhi since 2002 Domicile DELHI

Educational Qualification GRADUATED

Name & Address of SACHDEVA GLOBAL SCHOOL , DWARKA SECTOR – 18A, NEW DELHI
School attended

Applicant’s Signature ________________________________

Name & Address of TRINITY INSTITUTE OF PROFESSIONAL STUDIES , DWARKA SECTOR-10, DELHI
College attended
3 YEARS
Experience in Shooting (if
any) Click here to enter text.

NRAI Membership No. Click here to enter text. Shooter’s ID # SHM0702200208

Are you member of any If yes, please

other State / District Rifle Click here to enter text. attach details & Click here to enter text.
Club or Association? copy of M/Card

Is anyone in your family a

If yes, please
member of any other Click here to enter text. Click here to enter text.
attach details &
State / District Rifle Club
copy of M/Card
or Association?
Have you ever
Click here to enter text. If yes, please Click here to enter text.
represented any other
provide details
State or Unit in shooting?
Do you have a Arms Click here to enter text. If yes, attach Click here to enter text.
License? copy of License
Have you ever been NO
involved or convicted in Click here to enter text.
any criminal case / act ?
If yes, provide details. Click here to enter text.
TO REPRESENT DELHI STATE IN ALL SHOOTING COMPETITIONS ORGANIZED BY NRAI
Why do you wish to be a
member of DSRA ? Click here to enter text.

Have you applied for Click here to enter text.

DSRA membership before
Any claims for special Click here to enter text.
consideration for grant of
membership Click here to enter text.
I hereby declare that I am not a member of any organisation or group which has in any part of its programme, an
attempt to throw out the Govt of India by force, violence or any other illegal means. I further certify that I am not
associated with any person or group involved in any kind of terrorism. I wish to join Delhi State Rifle Association
(DSRA) with the sole aim to learn and practice target shooting sports. I declare that I have never been involved or
DECLARATION convicted in any criminal case or act; particulars and / or FIR, if any, has been attached hereto.I undertake that if
admitted to the privilege of membership of DSRA, I shall faithfully endeavour to fulfil the obligationsof
sportsmanship. I further declare that I have read the Memorandum and Rules of Association and fully agree to
abide by them as they are at present or as they hereafter be so modified or altered. I also understand that if any
information given by me is found to be incorrect or false, my membership shall be liable for cancellation.

Signature of Applicant Date

Signature of Parent, in
case of minor

Print this page and fill up by hand and sign

Recommendation by a Gazetted Officer of Government of India OR

a member of the Governing Body of Delhi State Rifle Association

Applicant’s Signature ________________________________

I certify that the applicant ____________________________________________________ is
personally known to me and I have verified all supporting documents attached with this application
from the original documents and on being satisfied about the authenticity of the same, I have
hereby recommend the above applicant for becoming a member of Delhi State Rifle Association.

Signature : _______________________________________

Name & Telephone Number

_______________________________________

Official Stamp: _______________________________________

========================================================================

Recommendation by any 2 Adult Life / Annual Membersof Delhi State Rifle

Association(Copy of Membership Card must be attached)

_______________________________ ______________ ___________________

Name of Life Member / Annual Member Membership No. Signature

_______________________________ ______________ ___________________

Name of Life Member / Annual Member Membership No. Signature

FOR OFFICE USE

Membership Approved / Rejected : _______________________________________
In the Governing Body meeting dated : _______________________________________
Category of membership approved : _______________________________________
Membership Number allotted : _______________________________________

Signature of Hony. Secretary : _______________________________________

Applicant’s Signature ________________________________