Mem. No.

m¬eÀervejeFìme& SmeesefmeSMeve
SCREENWRITERS ASSOCIATION
REGISTERED UNDER TRADE UNION ACT 1926 REGISTRATION NO. 3726
201-204, RICHA, PLOT NO. B-29, OPP. CITY MALL, OFF. NEW LINK RD., ANDHERI (W), MUMBAI - 400 053.
Tel.: 2673 3027, 2673 3108, 6692 2899 E-mail : swaindiaorg@gmail.com • filmwritersassociation@gmail.com • Website : www.fwa.co.in

meom³elee-He$e
MEMBERSHIP-FORM
cenemeef®eJe /Hon. General Secretary Date 20

m¬eÀervejeFìme& SmeesefmeSµeve
Screenwriters Association
Mumbai - 400 053.

cewQ SmeesefmeSMeve keÀe meom³e yeveves kesÀ efueS efveJesove keÀj jne / jner ntB ~ cesjer J³eefkeÌleiele peevekeÀejer Fme ÒekeÀej nw ~
I request you to enroll me as a Member of the Association, particulars regarding me are as follows -

veece / Name
efHelee /Heefle keÀe veece
Father/Husband’s Name

Gce´ /Age pevce leejerKe /Date of Birth

Mew#eefCekeÀ ³eesi³elee /Educational Qualification
efjueer]pe ngF& ef]HeÀuce/meerefj³eue/Dee@ef[³ees keÀ@mesì/Deueyece
Released Picture/Serial/Audio Cassestte/Album

efjueer]pe keÀe Je<e& /Year of Release

efHeÀueneue cewQ efueKe jne /jner ntB ~
At present I am writing

Helee /Address

ceesyeeFue /Mobile
F&cesue /E-mail HeÀesve /Telephone
cewQ Hetjer mel³eefve<þe kesÀ meeLe ³en Ieesef<ele keÀjlee/keÀjleer ntB efkeÀ GhejeskeÌle efJeJejCe mener nwQ leLee cegPes SmeesefmeSMeve keÀs efve³ece mJeerkeÀej nwQ ~
cewQ Gve veS efve³eceesW keÀes Yeer ceeveves keÀes yeeO³e ntB, pees mece³e-mece³e Hej yevee³es pee³esWies ~
I solemnly declare that the above mentioned particulars are true and correct and I agree to abide by the the exiting
rules and regulations of the constitution which I have read as well as those that may be formed time to time.

ÒeeLeer& keÀe nmlee#ej

Note : Proposed & Seconded by our Life & Regular Member only. Signature of Applicant

ÒemleeJekeÀ / Proposed by Name meom³elee ¬eÀ. / Mem. No. nmlee#ej / Signature

............................................................. .................................................. ..........................................

meceLe&ve /Seconded by Name meom³elee ¬eÀ. / Mem. No. nmlee#ej / Signature

............................................................. .................................................. ..........................................

 keÀe³ee&ue³e kesÀ Ghe³eesie kesÀ efueS / For Office Use Only
efvecveefueefKele jeefMe ®eskeÀ Üeje /vekeÀo ÒeeHle keÀer / Received the money as below:

DeeJesove He$e / Application Form Rs...........................

ÒeJesMe MegukeÀ / Admission Fee Rs...........................

Jeeef<e&keÀ MegukeÀ / Subscription for one year Form To Rs...........................

hen®eeve He$e / Identity Card Rs...........................

mebefJeOeeve HegefmlekeÀe / Constitution Book Rs...........................

oeve (mJes®íe mes) / Donation (Voluntarily) Rs...........................

HeefjmebIe MegukeÀ / Confederation Fee Rs...........................

[ekeÀ MegukeÀ / Postal Charges Rs...........................

kegÀue / Total Rs...........................

ÒeeHlekeÀlee& kesÀ nmlee#ej

jmeero veb. / Receipt No. efoveebkeÀ / Date Sign. of the receiver

HesÀuees meom³e / Fellow Member

SmeesefmeSì meom³e / Associate Member
efve³eefcele meom³e / Regular Member
DeepeerJeve meom³e / Life Member

efìHHeCeer
mJeerkeÀe³e&
Remarks
Approved by
Chq. No. Date:

Bank Name

Branch

ceeveo cenemeef®eJe
Hon. General Secretary

ÒeceeefCele keÀlee&
Verified By