Application Form

Roxilla Executive Travel Club - Membership Form

First Name *

Middle Name

Surname *

Did you ever have any other name(s)? *

If Yes, please mention your other names

Gender *

Father’s or Husband’s Name

Email *

Phone *

Your Country of Citizenship *

If Foreigner, are you a residing in India? *

Occupation *

Category of Membership *

Annual Income *

Do you use your own transportation?

If yes, which car do you have?

Car Registration Number: Upload RC Copy *

Emergency Contact *

Current Address *

Previous Address a) *

Previous Address b) *

Have you been convicted previously by any court of law in India or abroad? *

Govt. Issued Photo ID Proof Number * AADHAAR/PAN/VOTER ID/DRIVING LICENSE/PASSPORT *

ID Proof Upload *

Address Proof * AADHAAR/VOTER ID/DRIVING LICENSE/PASSPORT*

Passport Size Photo *

Please provide your hometown: * *

Have you ever been a Member of Roxilla Executive Travel Club *

If Yes,Please Provide your Membership Number

Has your membership ever been cancelled due to default by RETCIL*

If Yes, Cancellation Details

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