IPCTN CONNECT ID – APPLICATION

Title *
—Please choose an option—RevPrDrEldEvgMrMrsMs

Full Name *

Father's / Husband's Name *

Wife's Name (if applicable)

Date of Birth *

Blood Group *
—Please choose an option—A+A-B+B-AB+AB-O+O-Other

Mobile Number *

Email ID *

Emergency Contact Number *

Permanent Address *

Residential Address *

Upload Photo (Recent, White Background, Max 4MB) *

Credential / Ordination Type *
—Please choose an option—Ordained PastorLicensed / Ordained EvangelistCommissioned EvangelistDistrict PastorBeliever PreacherRecognized Woman EvangelistCouncil MemberOther

Ordination Date *

Ministry Station / Church Name *

Church Status *
Owned — IPCOwned — IPC (Founding Pastors)LeasedRentedAffiliatedNon-AffiliatedNo Church / Outstation

Other Associated Land / Property (Select all that apply)
CemeteryParsonageOtherN/A

Is this land registered with IPC?
Yes, Registered with IPCNo, Not RegisteredN/A

District / மாவட்டம் *
—Please choose an option—AMSI CENTERARUMANAI CENTERATTOOR CENTERCHENGALPET EAST CENTERCHENNAI – AMBATTUR CENTERCHENNAI – CENTRAL CENTERCHENNAI – METRO CENTERCHENNAI – NORTH EAST CENTERCHENNAI – THIRUVALLUR KANCHIPURAM CENTERCHENNAI – WEST CENTERCOIMBATORE – NORTH CENTERCOIMBATORE CENTERDINDUKAL CENTEREDAICODE CENTERKALAKKAD CENTERKODAIKANNAL CENTERKUMBAKONAM CENTERMADURAI CENTERMARANCONAM CENTERMARTHANDAM CENTERMAYILADUTHURAI CENTERMUGILANKARAI CENTERNAGERCOIL CENTERNELLAI – NORTH CENTERNELLAI – SOUTH CENTERPALLAVILAI CENTERPANACHAMUDU MISSION AREAPERAMBALUR CENTERPOLLACHI CENTERSALEM CENTERTENKASI CENTERTHENI CENTERTHIRUVARUR CENTERTHOOTHUKUDI (TUTICORIN) CENTERTHUNGAVI CENTERTIRUPUR CENTERTRICHY CENTERWATRAP CENTEROther

Date of Joining IPC Ministry *

Years of Ministry Experience *

Educational Qualification *
—Please choose an option—High School (10th)Higher Secondary (12th)DiplomaBachelor's Degree (B.A. / B.Sc. / B.Com.)B.D. (Bachelor of Divinity)M.Div. / M.Th.Ph.D. / D.Min.Other

Bible College / Seminary

College Name and Location

District Pastor Name *

Previous ID Card Number (if renewal – leave blank for new)

Ministry / Church Address *