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APPLICATION FORM

Date : ____________

Place : ____________

The Principal,
Jai Hind College,
Basantsingh Institute of Science &
J. T. Lalvani College of Commerce,
'A' Road, Churchgate, Mumbai - 400 020.
Maharashtra, INDIA.

Dear Sir,
 
I  wish to apply for Ordinary / Life / Patron * Membership of the Association. Required particulars have been furnished overleaf. I agree to abide by the Memorandum of Association / Constitution and bylaws / rules and understand that my admission is subject to the approval of the Executive Committee.
 
Enclosed is the Ordinary / Life / Patron * Membership fee of $ ______ Dollars.
( * Delete two of three categories as desired )

Thank You,

Yours Sincerely,
 
 

Signature
 

PERSONAL PARTICULARS

1. First Name :   _________________________________________________________

2. Middle Name :  ________________________________________________________

3. Surname :  ____________________________________________________________

4. Date of Birth : Month________Date__________Year___________

5. Educational Qualifications :  ______________________________________________

6. Studied at Jai Hind College : From Year__________To Year_________

7. Martial Status : Married / Single

8. No. of children : _____

9. Names of children, if any, who are Alumni of Jai Hind College : ___________________

    ______________________________________________________________________

10. Residence Address :  ____________________________________________________

    ______________________________________________________________________

    Pin ______________

    Res. Tel. __________________

11. Company / Organization : ________________________________________________

    Address : _______________________________________________________________

    _______________________________________________________________________

    Pin ______________
 
    Designation _____________
 
    Off. Tel.____________

12. Nature of Business : ______________________________________________________

13. Can assist with : _________________________________________________________

14. Correspondence / Communication to be sent to Residential / Office * Address
( * Delete one as desired )
 

Date _______________
 

Signature ______________________
 


FOR OFFICE USE ONLY    

RECEIVED _______________________ APPROVED_______________ INTIMATED____________

CHEQUE / DRAFT - AMOUNT $ _______________________

NO.______________ DATED_____________ DRAWN ON_____________________

RECEIPT NO._______________ DATED________________

MEMBERSHIP NO.__________/______ ______ _____ _____