Kerala Non-Resident Keralites Welfare Board
NB:- Use only English for filling up the form
to change previous data
1. Registration Type*
2. District*
3. Taluk*  
Maximum Size : 50Kb , File Type : jpg / gif / bmp
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
14.  Do You Have a Valid Identity Card Issued from NORKA, a Kerala Government Venture Yes No
If Yes, Identity Card No.
15.  Passport No. *
Expiry Date of Passport*
Name of Place Issued Passport*
(Produce copy of passport with this application if you don’t have NORKA’s Identity Card)
16.  Type of Employment in Foreign Country
( Self employed/Business/Livelihood )
17.  Specify the Name of Place in Which You Are Currently Working Country/District/Place*
18.  In Case of Any Pre Employment, Specify the Type of Employment
19. Date of Residence
20. If You Are Staying or Working in Foreign Country, Specify the Date of on Which You Decided to Go to Foreign Country
21. Visa No./Date *
Name of the Country Issued (Produce Copy)*
22. Address in Foreign Country
i. Educational Qualification of Applicant *
ii.Religion/Caste *
iii.Marital Status*
23. Whether the Applicant is a Member of Any Other Welfare Fund Board Yes No
If Yes Names of Board, Registration Number, District*
24.  Are You Working in Abroad on Deputation or on Leave From Any Permanent Employee Post in Central Government/ State Government/Public Sector Undertaking in India Yes No
(If yes give the details)
25.  Any Other Details
Nomination Details
Name Age Relation Either
If Nominee
Percentage of Benefit