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Me M Ship Applicationform

This document is an application form for membership to the Professional Social Workers' Association. It requests personal details like name, date of birth, address, qualifications, occupation, organization details, and payment details. Applicants must provide documents like degree certificates and identification proofs along with the filled form.

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anon_949456529
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37 views2 pages

Me M Ship Applicationform

This document is an application form for membership to the Professional Social Workers' Association. It requests personal details like name, date of birth, address, qualifications, occupation, organization details, and payment details. Applicants must provide documents like degree certificates and identification proofs along with the filled form.

Uploaded by

anon_949456529
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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APPLICATION FOR MEMBERSHIP


PROFESSIONAL SOCIAL WORKERS' ASSOCIATION (PSWA)
(Since 1985)
E-mail: [email protected] / www.PSWA.org.in
Ofce: Mr. S. Cyril Alexander, President, PSWA, C/o MACT, 39/8, Starling Apartments,
Akbarabad 2nd Street, Kodambakkam, Chennai - 600024. Tamil Nadu State, India.
Tel.: +91-44-24721579. Mobile: 9444011035 / 9444020563.
KINDLY FILL ALL THE DETAILS IN CAPITAL LETTERS.
Member Status : Student /Practitioner
Membership Type : Student / Annual /Life
Name of the Applicant :
Fathers Name(epansion of !nitial" :
#ate of $irth :
Permanent Address :
%ommunication Address :
(!f different from Perm& Address"
%ontact Ph& / Mobile / FA' :
%ontact (mail :
)ear of Passin* MS+ / MA (S+" :
Speciali,ation (if any" :
%olle*e Name - Address :
.ther /ualifications (if any" :
.ccupation : Self0(mployed / 1o2t& / N1. / Fundin* A*ency
(.thers Specify"
#esi*nation at 3or4 (if any" :
.r*ani,ation Name / %ontact #etails :
PSWA Application for Membership
Recent Colour
Photo
to be pasted and
attested by
applicant
with date
2/2
Payment Details:
Meme!s"i# Fee (Tick): 5s&677 (Student" / 5s&228 (Annual" / 5s&69 728(:ife;"
M$de: %ash /%he<ue /#emand #raft (Please add Rs.5!" for outstation che#ue$.
Payment should be madeonly in fa2our of %P!$fessi$nal S$&ial '$!(e!s) Ass$&iati$n*
payable at C"ennai&
* it is mandatory for %ife Members to renew their membership e&ery fi&e years with updated
information.
(nclosed please find a %he<ue / ## / %ash for 5s&==========/0 (bein* the membership
fee for Student / Annual / :ife"& The %he<ue / ## may be encashed incase my
Application is appro2ed by the PS+A9 other3ise returned to me for %ancellation& %he<ue
/ ## No&=============== dated================== dra3n on $an4 -
$ranch==================================================================
!=========================================================hereby solemnly
affirm that ! shall abide as per terms - conditions of the Association and to respect the
constitution of the PS+A and all the directi2es issued by the Association from time to
time&
Pla&e:
Date: Si+natu!e $f A##li&ant
En&l$su!es:
6& A 5ecent Passport Si,e - Stamp Si,e Photo*raph for the purpose of issuin* Membership
!dentity %ard and %ertificate&
2& Self0Attested %opy of MS+ / M&A(S+" #e*ree %ertificate / %opy of Student !dentity
%ard (for Student membership"&
>& Self0Attested %opy of MS+ / M& A(S+" %ourse Transfer %ertificate&
?& Self0Attested %opy of Permanent/%ommunication address proof 3ith Photo !dentification&
N$te: A##li&ati$n t$ e sent $nly t$ Offi&e Add!ess as a$,e-
OFFICE USE ONLY
The above ______________Membership Application has been ACCEPTED / REJECTED at
the Executive Committee / Ofce Bearers meeting held on _______________.
President, PSWA Secretary, PSWA
Application Received Date Receipt No.
Membership No. Receipt Date
PSWA Application for Membership
DECLARATION
DECLARATION

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