ഷെഡ്യൂൾ I - അംഗത്വ അപേക്ഷാ ഫോംSchedule I - Membership Application Form

ഈ ഫോം പൂരിപ്പിച്ച് പ്രിന്റ് എടുത്തു ഒപ്പിട്ട് സൊസൈറ്റി ഓഫീസിൽ സമർപ്പിക്കുക.Fill out this form digitally or print it out to submit physically at the Society office.

SCHEDULE – I

വിദ്യാമിത്ര എഡ്യൂക്കേഷണൽ കോ-ഓപ്പറേറ്റീവ് സൊസൈറ്റി ലിമിറ്റഡ്VIDHYAMITHRA EDUCATIONAL CO-OPERATIVE SOCIETY LTD.

(രജിസ്റ്റേർഡ് ഓഫീസ്: എറണാകുളം ജില്ല)(Proposed Registered Office: Ernakulam District, Kerala)

APPLICATION FOR ADMISSION AS A MEMBER

Application No.: ___________________________Membership No.: ___________________________
Date: ____ / ____ / 20____

To
The Board of Directors,
VidhyaMithra Educational Co-operative Society Ltd.,
Ernakulam District.

1. PARTICULARS OF THE APPLICANT

1. Full Name (in block letters):
2. Name in Malayalam (if any):
3. Father's Name:
4. Mother's Name:
5. Spouse's Name:
6. Gender:        
7. Date of Birth:8. Age:
9. Nationality:10. Religion:
11. Occupation / Profession:Professional Skill:
12. Educational Qualification:13. Employer / Institution:
14. Annual Income:

2. IDENTITY DETAILS

ID Type / Document:
Government ID Reference:

3. ADDRESS DETAILS

Permanent Address:
Village / Taluk / District:
State & PIN Code:PIN:
Communication Address:

4. CONTACT DETAILS

Mobile Number 1:Mobile Number 2:
WhatsApp Number:Email Address:
Emergency Contact:

5. FAMILY DETAILS (For Education & Benefit Eligibility)

Sl. No.Name of Family MemberRelationshipAge
1
2

6. MEMBERSHIP DETAILS

Type of Membership:      
Category:        

7. SHARE SUBSCRIPTION DETAILS

Number of shares applied for:
Face value per share:₹2,500/-
Total share value:₹25,000/-
Entrance fee & other charges:₹ __________________

8. PAYMENT DETAILS

Mode of Payment:         
Transaction / UTR Number:Bank & Branch:

9 & 10. EDUCATIONAL INTERESTS & SOCIETY PARTICIPATION

I am interested in contributing to / utilizing: Coaching, Digital Education, Skill Development, Workshops, Administration, Tech Development, and Student Support Programmes.

11. NOMINATION DETAILS

Name of Nominee:Relationship:
Date of Birth:Entitlement Share:

12. BANK ACCOUNT DETAILS (For Dividend Payouts)

Account Holder Name:Bank Name & Branch:
Account Number:IFSC Code & UPI ID:

13. DECLARATION BY THE APPLICANT

1. I have completed eighteen years of age and am competent to enter into contracts.
2. I agree to abide by the constitution, bylaws, rules, and resolutions of the Society.
3. The information furnished by me is true and correct, and I undertake to pay all dues.

___________________________________

Signature of Applicant

Date: ____ / ____ / 20____

Place: ____________________

14 & 15. FOR OFFICE USE ONLY

Application No: _______________Date of Receipt: _______________Shares Allotted: _______________
Membership No: _______________Resolution No: _______________Admission Date: _______________

___________________________________

Secretary

___________________________________

President / Board Member