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INSTITUTE OF RAIL
TRANSPORT
New Delhi - 110001 Phone : (011) - 3384171, Fax : (011) - 3384005 Membership Form for Members/Associates |
Please affix photo if available |
| 1. | Name (In Block Capital) : | _______________________________________________________________ | ||
| 2. | Educational Qualifications : | _______________________________________________________________ | ||
| 3. | Occupation and Address ( Please also give exact designation and present pay, if in service) : |
Office _________________________________________________________ ______________________________________________________________ Residence ______________________________________________________ ______________________________________________________________ |
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| 4. | Railway in which working (For Railwaymen only) : | _______________________________________________________________ | ||
| 5. | Date of Birth : | _______________________________________________________________ | ||
| 6. | Experience : | _______________________________________________________________ | ||
| 7. | If member of similar Institute, its name and class of membership : | _______________________________________________________________ | ||
| 8. | Name of the Zonal Branch to which you desire to be attached. Recommendation of member to come through Zonal Secretaries : | _______________________________________________________________ | ||
| 9. | The particulars furnished by the applicant are true to the best of my knowledge and belief. I recommend that he may be admitted as a Life Member/Associate of the Institute. | |||
| 1) |
Signature _______________________________________________________ Name and Address _______________________________________________ IRT Membership No. _____________________________________________ |
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| 2) |
Signature _______________________________________________________ Name and Address _______________________________________________ IRT Membership No. _____________________________________________ |
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| 10. | To be signed by the Applicant | |||
I certify that the particulars given in my application are true to best of my knowledge and belief. I also agree to abide by the Rules and Regulations of the Institute as in vogue and amended from time to time. I also guarantee that I will not take action prejudicial to the interest of the Institute. |
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I enclose herein a Cheque/Demand Draft/Cash for Rs.1000/- (Rupees one thousand only) towards my Life Membership Associateship Fee |
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| Encl : |
1) Cheque No.__________________________Dated____________________________________ Drawn on___________________________Bank_____________________________________ Branch______________________________________________________________________ 2) DD No.____________________________Dated______________________________________ Drawn from_________________________Bank_____________________________________ Branch______________________________________________________________________ 3) Cash Rs.______________________________________________________________________ |
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| * | In case of outstation cheques, please add Rs.25/-(Rupees Twenty Five Only) to cover Bank charges. | |||
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