Citizenship ID

Name

Gender Select one Male Female

Category Select one Civil servantJudiciaryOthers

Email

Alternative Email

Mobile

Alternative Mobile

Organization

Dzongkhag Select one BumthangChukhaDaganaGasaGelephuHaaLhuentseMongarParoPemagatshelPunakhaSamdrup JongkharSamtseThimphuTrashigangTrashi YangtseTrongsaTsirangWangdue PhodrangZhemgang

Amount* (*monthly contribution)

Account Number

Bank Name Select One Bank of Bhutan LimitedBhutan Developement Bank LimitedBhutan National Bank LimitedDruk PNB Bank LimitedT Bank Limited

Start Date

To Date