The Hon. Gen. Secretary Date: _______
Dear Sir,
I Apply for Donor / Patron / Life Membership of The Bombay East Indian Association.
I declare that I am an East Indian by birth. I have completed18 year of age.
Details of myself:
- Full Name:_______________________________________
- Date of Birth:______________________________________
- Address- Resident:__________________________________
- Telephone No.:______________________________ E-Mail:____________________
- Educational Qualifications:___________________________
- Occupation:_______________________________________
- Details of Family :
- Name of the Father:__________________________
- Place of Origin:______________________________
- Present Address:_____________________________
- Membership:________________________________
Membership: Patron Rs. 2000/-; Donor Rs. 500/-; Life Rs. 50/-
Paid by: Cash/Cheque No:______________Dated:_______________
Yours Sincerely:__________
Applicant's SignatureProposed by: (1) Name:__________________________
Address:________________________
Membership Number:_______________
Seconded by: (2)Name:__________________________
Address:________________________
Membership Number:_______________
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FOR OFFICE USE ONLY
Admitted vide Resolution of Managing Committee on ________________________
Name:_________________________________
Address & Telephone No.:________________
______________
Verified By:____________________
Sd/-
Hon. Gen. Secretary