MEMBERSHIP APPLICATION FORM FOR ENROLMENT OF MEMBERS

All India Postal & RMS Pensioners Association

___________________________District ________________________Circle

 

MEMBERSHIP FORM

1. Name of the Pensioner                                 :
2. Postal Address with PIN No.                       :

 

3. Landline & Mobile Phone Nos.                   :
4. Email ID if any                                                    :
5. Date of Birth                                                      :
6. Date of entry in Government Service     :
7. Date of retirement                                          :
8. Post held at the time of retirement         :
9. Office worked at the time of retirement               :
10. Scale of Pay at retirement time                 :
11. PPO Number & Issuing Authority              :
12. Post Office SB or Bank where pension

Is received         

                                                :

13. Total Service in Department                        :

 

14. Annual Membership remittance details : Cash __________ / Cheque/DD No._____________

 

15. Any other details if any                                 :

DECLARATION

 

I declare that I am a Postal Pensioner and I wish to join as a basis member of the ________________________ Division / District Postal & RMS Pensioners Association. I understand that this is a voluntary association to work for the welfare of the pensioners and I assure that I shall abide by the bylaw of the Association and I am remitting this annual subscription of Rs._______ for the period from April _______ to March _______.

 

 

Date: ___________________                                                                                                                                                                            Signature of the Pensioner