,

( , : 605/-2/2003, )

Application for Membership

1. :
Name
2. :
Fathers Name
3.
Date of Birth
4. :
Permanent Address
5. :
Mailing Address
6. / :
Telephone / Mobile No.

Designation
/
Office - Dept./Section
/

Date of regular /
continuous
appointment in the
Institute

DECLARATION

,
|

I willingly apply for membership of Joint Employees Association, Bipin

Tripathi Kumaon Institute of Technology, Dwarahat.

/
|
All the rules / bye-laws of the association have been carefully read / heard by
me and I undertake to completely abide by them.

300/- ( ) 20/-
/ |
I undertake to deposit towards the membership of the Association, a non-
refundable sum of Rs. 300/- (one-time) and regularly Rs. 20/- per month in
form of monthly deduction from my salary / in person.

|
I am not a member of any other employee association.
To,
The Director
Bipin Tripathi Kumaon Institute of Technology
Dwarahat, Almora

Subject: Letter of Authorization.

Sir,
I (Name &
Designation) being a member of Joint Employees Association, Bipin Tripathi
Kumaon Institute of Technology, Dwarahat, hereby authorize deduction of
monthly subscription of Rs. 20/- starting from ______________ (month & year)
onwards from my salary and its payment to the above mentioned
employees association.

Signature:
.
Name:

Designation:

Office:
..
Date:

TO BE FILLED BY THE ASSOCIATION

It is certified that Mr. / Ms. is

a member of Joint Employees Association, Bipin Tripathi Kumaon Institute of
Technology, Dwarahat, Almora (Uttarakhand).

President

Date: