Application For Membership

Membership Approved on

Date

SHARES ALLOTED

Nos.

I wish to apply for admission as member of tho aforesaid Bank. I have carefully read its Rules and Bye-Laws. I hereby agree to abide by them. I am not a member of any Bank or credit society. I request that the Board of Directors may allot me

shares of Rs. 100/- each and I hereby agree to accept the same or lesser numberwhich may be allotted to me. I also agree to deposit In full share money.Compulsory Deposit along with admission fee etc. as per Bank's Bye-Laws.

Nominee Name

Nominee Age

Nominee Address

Nominee Relation

as the parson in interest fot delivery of my shares. deposit (after payment of Bank's loans. dues etc. If any) on my account in the Bank after my death.

Name in full

Father's/Husband's Name

Caste

Age

Occupation

Name and address of Employer/Business Piace (in full)

Phone No. Residence

Phone No. Office

Residence Address

Pay or Income

Debts, If any