membership_form
DESCRIPTION
ÂTRANSCRIPT
Numismatic Society of Calcutta
Membership Application Form
No. Dated
Important Note : Please fill the form in CAPITAL letters, Sign in BLACK Ink.
ToThe Hony. General SecretaryNumismatic Society of CalcuttaKolkata-87
Dear Sir,I hereby apply for Membership of the Society for PATRON LIFE ANNUAL category. Iabide by the rules and regulations of the Society, and all the rules/ regulation of our country.Isolemnly declare that no criminal / civil proceeding is pending in my name in any court of law.
Name: Mr./Mrs./Ms./Dr.First Middle Last
Father’s / Husband’s Name
Date of Birth: (yyyy/mm/dd) / / Nationality
Qualification Occupation
Permanent Address
Pin Code
Correspondence Address
Pin Code
Phone Number Mobile Number
Email id
Identification Document No.
Address Proof Document
Areas of intrest in Numismatics
Enclosed herewith CASH/ CHEQUE for Rs. Cheque No.
Dated on
(Registered under the West Bengal Societies Act, 1961)Space No. 02-39B, Hudco Building, 2nd Floor,
15N, Nelie Sengupta Sarani, Kolkata - 700 087.web: www.nsckolkata.com, e-mail:[email protected]
FOR OFFICE USE ONLY
Application Received :
Passed on :
Membership No. :
Money Receipt No. :
MEMBERSHIP FEE:
ANNUAL : Admission Fee Rs. 200/- +Rs.300/- per year
LIFE : Admission Fee Rs. 200/- +Rs.3000/-
List of Documents :
Two Copies of recent passport size colour photo
Photo ID Proof:(Xerox of any one required)1. Passport2. Voter’s ID3. Driving License4. PAN Card
Address proof:(Xerox of any one required)1. Ration Card2. Latest copy of Life Insurance Policy3. Latest Electricity Bill4. Latest Telephone Bill (Landline/Mobile)
All payments must be made by crossed Cheques/ Demand Drafts favouring“Numismatic Society of Calcutta” and should be drawn on/payble at Kolkata.
Outstation cheques will not be entertained.
Application of Membership is subject to approval of the executive committee
Proposed by :
1. Name Membership No. Signature
2. Name Membership No. Signature
Signature