Monday 18 November 2013

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.                       :

 

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

Is received         

                                                :

  1. Total Service in Department                        :

 

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

 

  1. 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

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