To,


सांध्य दैनिक

जनबिम्ब

अखबार नहीं ,एक आन्दोलन


Application form for authorization as

Samvad Suchak(News Informer)/Reporter/part time Reporter/Stringer


PART-1


Name (Mr./Mrs./Miss) _______________________________________


Father/Husband’s name _____________________________________


Age ________________ Date of Birth __________________________


Telephone / Mobile No. ______________________________________


Email __________________________________________________


Present address _______________________________________________________________________

____________________________________________________________________________________

District _____________________ State _______________________ Pincode ______________________


Permanent address _________________________________________________________________

____________________________________________________________________________________

District _____________________ State _______________________ Pincode ______________________


Educational Qualification ________________________________________________________________


Technical/Professional/any other qualification/Experience (if any) _______________________________

____________________________________________________________________________________


Present occupation & monthly income ______________________________________________________


Do you have any experience in working in print or electronic media or as freelance journalist/reporter? If

yes, please provide details _______________________________________________________________

____________________________________________________________________________________


Any other detail(s) that you would like to give _______________________________________________

___________________________________________________________________________________


Reference ( Name, occupation, Email Id, Phone No.and I.D.Code of a person who is already our Samvad Suchak/Reporter and whom you know very well) ____________________________________________________

____________________________________________________________________________________

___________________________________________________________________________________


I have well understood all the terms & conditions & hereby promise to abide by all the rules & regulations of the organization.

Date ___________________ Signature ____________________________


PART-2

Details for Mediclaim policy,Accident Insurance policy etc.


Name of Applicant-

Relationship-  Self

Date of Birth-

Gender-

Age-


Details of dependents:

1-

Name-

Relationship-  

Date of Birth-

Gender-

Age-


2-

Name-

Relationship-  

Date of Birth-

Gender-

Age-


3-

Name-

Relationship-  

Date of Birth-

Gender-

Age-


Please attach(with e-mail/form)

1- Scanned copy of I.D.proof such as Voter Card, Aadhaar , Passport or Ration Card.

2- Attach Passport sized Photograph


General Details

(1) Please fill in complete details in the Application form meant for authorization as

Samvad Suchak(News Informer),Reporter/part time reporter/stringer and e-mail it to janbimb@gmail.com. Don’t leave any column unfilled or unanswered.

(2) Necessary instructions/training , reporter Identity card and related material will be provided on selection & completion of membership/authorization procedure. After this, he/she will be authorized to send news/reports to the organization.

(3) Please note this is not a full time appointment and any person involved in any work/occupation/job with intention of doing something for the society & country can work as our Samvad Suchak/Reporter.

(4) The final rights to accept/reject any application rests with the organization & applicable to all.

(5) You can contact our State Bureau Chief/News coordinator for any assistance/information regarding application process.


Work/Responsibilities of the Reporter

(1) Provide us special news/report after investigation/preparation/coverage. Inform the Chief News Coordinator for the news that you can’t do/cover yourself.

(2) Those reporters having their own camera can also send news photos .

(3) Don’t do any work which can tarnish the image of the organization. Authorization as reporter would be cancelled in such condition and Id card will be cancelled/taken back with possibility of initiating judicial/police action.

(4) Pay special attention for raising corruption, mafia-raj, police-raj & other serious issues of public interest.