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ffi$D Canteen Stores Deparlment

EXCLUSIVE SHOP
APPLICATION FORM FOR MEMBER CARD
----------.:----

NAME OF THE APPLIGANT

Personal Number Rank

Attested Passpor[
Arms/Service/De pa rtrn e nt Un iUOrgan ization size Photo in
Ijniform for
defence personlel ,.

a,
Date of Retirement in Present Rank e
Date of Blrth
(lncl LPR Period) Sporrse

lv4obile No
NAME OF THE SPOUSE

Previously Any Exclusive Card issued (Yes/No). lf yes then specify the reason for new application
with detail info ---------

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Applicants Signaturo Date

P.ank and l.lame

UniUDepartmen( Formation/Organization Signature & Seal

Application t" [l o.t"

[----l csD Membership No[m
Card Delivery Date
Authorized Signature Seal

lT S..b". Card Secton Paid l---_l Not Paid IL---l | '

Apprication*"
F 0.," f_- --l
Card Delivery Daie I f
Auihorized Signature
Canteen Stores Department
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CSDIT -,

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EXCLUSIVE SHOP
. APPLICATION FORM
FOR FAMILY CARD HOLDER

NAME oF THE AP!!I!AMI_EAMI!Y, CARD HOLDER)

MEMBEB CARD HOLDER DETAILS

ersonal Number

Arms/Service/Depa rtme
Date of Birih
ALtostcd Passl.rot't
nt UniUOrga nization sizc Phrtto in
ljniiorrn lor
defence pcrsr-,;ru.rul
Date of Rotirernent in Present Rank ct
(lnci LPR Period) Spouse

Mobile No

Freviously Any Exclusive Card lssued (Yes/No) lf yes, rhen specify the reason for new application
wilh detail info, ----'---

Date

Rank and Name

U niUDe partmen t Forrl ation/Org an)zation Signature & Seal

Abpricarion N" [----l outu

f---_--l csD Membersh)p Noml-j
Card Deiivery Dato
Authorized Signature Seal

: lT Section Card Section Paid Not paid

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ApplicationNo | | oate I --_l

Caro-crerivdry Date
Authori,ed Sinn:rr,.-