Kerala Non-Resident Keralites Welfare Board
ONLINE REGISTRATION

Phone: +91 471 278 5500/502/503
Chief Executive Officer : +91 471 278 5512
Manager (Finance): +91 471 278 5513
(IST 10:00 am to 1:00pm and 2:00 pm to 5:00)
Fax: +91 471 278 5501
E mail : info@pravasiwelfarefund.org
Web Site : www.pravasikerala.org

NB:- Use only English for filling up the form
to change previous data
1. Registration Type*  
2. District*  
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Photo*
Signature*
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3. Taluk*  
4. Village  
5. Registration Date*  
6. Applicant's Name*  
7. Male/Female  
8. Husband/Father's Name *  
9. Date of Birth,Age*  
10.  Permanent Address in Kerala *
(Including Post Office,Pincode)
 
11. Telephone No.  
Mobile No.(India)*  
. Check this box if Permanent Address and Communication Address are the same
12. Complete Address for Communication *
(In India)
   
Pin Code
*
13. E-mail Address  
Nomination Details
Name Age Relation Either
Nominee
If Nominee
Percentage of Benefit