INTERNAL MIGRATE WORKERS PROTECTION SYSTEM (INDIA)

INDIAN MIGRANT WORKER
MEMBERSHIP REGISTRATION FORM

WWW.IMWPSINDIA.ORGEMAIL: ADMIN@IMWPSINDIA.ORGOFFICE NUMBER: 080-49524992

APPLICATION NO: Assigned on submissionDATE: 07/10/2026

Complete your details below. Fields marked * are required. Office-use details are completed by IMWPS.

Full name *Father / husband / others * Father / husband / other name *Gender * Marital status * Date of birth *Aadhaar number *State *District *PIN code *Village *Phone number *Alternate numberEmail IDSignature of migrant (typed full name) *

REQUIRED DOCUMENTS: 1. AADHAAR CARD XEROX COPY – 1 2. PASSPORT SIZE PHOTO – 1

Aadhaar card copy *Migrant signature image (if applicable)Other KYC document like PAN / Driving Licence (if applicable)

Other KYC documents may include PAN card, Driving Licence or a similar identity document. JPG, PNG or PDF, maximum 5 MB per file. Your details and documents are accessible to authorized administrators for membership processing.

FOR OFFICE USE ONLY — GENERATED AUTOMATICALLY

Authorized signatureReference numberRegistration numberMID numberDateBranch codeSignature of the manager

REGISTRATION FEES RS.300/- AND DOCUMENTATION CHARGE IS RS.50/-

Total: ₹350. This form does not collect payment. Contact the office for payment instructions.