Surat

Dr. Mukesh P. Jagiwala

Hon. Treasurer, IPS
101, Shriji Nivas, Opp. Dhiraj Sons,
Nr. Mansukh Tower,
Gajanan Book Stores Lane,
Athwa Gate, SURAT 395001 Gujarat India
Mobile: 9879521795
Email: treasureripsmpj1618@gmail.com
mukeshjagiwala@yahoo.co.in

The complete form should be directly sent to the Hon. Treasurer: Dr. Mukesh P.Jagiwala, 101, Shriji Nivas, Opp. Dhiraj Sons,
Nr. Mansukh Tower, Gajanan Book Stores Lane, Athwa Gate, SURAT 395001 Gujarat India, Mobile: 9879521795,
Email :treasureripsmpj1618@gmail.com, mukeshjagiwala@yahoo.co.in. along with an application fee of Rs. 200/- (Non
refundable) and the Subscription amount as given under :

Surat