उमेद सहकारी पतसंस्था लि.

Registration No.: B.O.M / W.H.E / R.S.R / C.R / 617 / Year 1986-87
Ground Floor, Rishi Prasad, C-45, 165, Shantinagar, Ulhasnagar 421003

सभासद अर्ज | MEMBERSHIP FORM

To | प्रत
Director | संचालक
Umed Sahakari Patsanstha Ltd.
उमेद सहकारी पतसंस्था लि.
Date / दिनांक: __ / __ / ______

I am hereby furnishing my detailed information to become a member and a shareholder of the company.
माझी संपूर्ण माहिती पुढील प्रमाणे असून मला आपल्या कंपनीचा भागधारक करून सभासदत्व द्यावी ही विनंती.

सभासदाचे नाव | Applicant’s full name
Father's Name | वडिलांचे नाव
Mother's Name | आईचे नाव
Spouse Name | जोडीदाराचे नाव
Gender | लिंग
Date of Birth | जन्मदिनांक
Occupation | व्यवसाय
Marital Status | वैवाहिक स्थिती
Caste | जात
Religion | धर्म
PAN | पॅन
Adhaar No. | आधार क्र.
Education | शिक्षण
वारसदाराची माहिती | Nominee Information
Mobile No | मोबाईल क्र.
Address | पत्ता
Relation | नाते
परिचय देणाऱ्याची माहिती | Introducer Details
Name | नाव
Membership No. | सभासद क्र.
Mobile No | मोबाईल क्र.
सभासदचा पत्ता | Member’s Address
Field Current Address
(सध्याचा राहण्याचा पत्ता)		 Native Address
(मळ गावचा पत्ता)		 Work Address
(कामाचा पत्ता)
Flat / Building
Street
Landmark
Location
State
District
Taluka
City
Pin Code
Mobile No.
Email
घोषणा | Declaration
I, Mr./Mrs , hereby declare that the information mentioned in this application form is true and correct. I have been explained all the rules of the society and the terms and conditions to become a member of Umed Sahakari Patsanstha Ltd., and they are acceptable to me. I acknowledge that information provided by me to the society in this form and from time to time may be used by the society for the purpose of its ordinary course of business and it is acceptable by me. Thereby, I request you to accept my membership application and issue me a number of shares of Rs. ____- each. I am ready to pay an additional Rs. ____ as membership fees. In case the above information is incorrect, you may cancel my membership.
"I hereby give my consent to become a member of Umed Sahakari Patsanstha Maryadit and agree to abide by the rules and regulations of the institution."
FOR OFFICE USE ONLY
Membership No. ______________________
Date of Approval ____ / ____ / ________

Verified & confirmed all the above details.

Manager’s / Authorized Signatory’s Signature & Stamp