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35, Taluk office Road, Saidapet, Chennai-15. Phone: 22300190 APPLICATION FOR LIFE MEMBERSHIP Form A LM No:.

Details of the Amount Received Entrance fee Rs.10/- (Rupees Enrolled as life Member on Ten Only) Vide Receipt No:.Dated President General Secretary Life Membership Subscription fee Rs.../Rupees........................................... Member was informed about this enrolment in Letter No/Member Enrolled Dated ......only) .. Vide Receipt No..Dated... General Secretary From Er. . . . . To The General Secretary Association of Tamil Nadu Highways Engineers 35, Taluk Office Road, Saidapet, Chennai-600 015. Dear sir, I hereby apply for Life Membership of the Association to Tamil Nadu Highways Engineers in accordance with the Bye-Laws as they now stand or as they may be altered hereafter. I, do hereby promise that , in the event of my enrolment as life Member I will be governed by the Bye Laws and Regulation of the Association as they now are, or as may hereafter be legally altered and that I will accept as final and binding the decisions of the committee in all matters dealt with by them in accordance with the provisions of the Bye Laws and Regulations, and will forthwith cease to describe myself as Life Member or to designate myself as belonging to the Association in any other form , on receipt of a notice from the General Secretary that acting under the power conferred upon him by the Bye-Laws and regulations the committee have declared me to be no longer a Life Member of the Association. I further undertake that I will promote the objects of Association as far as may be in my power, provided that whenever I shall signify in writing to the General Secretary that I am desirous of withdrawing from the Association I shall, after the payment of any arrears may be due by me at that period, he free from this obligation. I accept responsibility for accuracy of the particulars contained in the application from with regard to my qualification. I also undertake to abide by conduct rules that the committee may frame from time to time. I am herewith sending (i)


Entrance fee of Rs. 10/- (Rupees Ten only) Life Membership subscription of Rs..../-(RsOnly)

Station : Date : Signature of Applicant

1. 2. 3. 4. 5. 6. 7. 8. Name (in Block Letters) Son/ Daughter/ wife of Date of Birth Native place, Taluk & District Qualification Year of TNPSC and Rank Date of joining in the Department Office Address District.PIN: 9. Address for communication & for sending High News District.PIN: 10 . Permanent Address District.PIN: SUPPORTERS: From the personal knowledge of applicant and in consideration of qualification I recommend to the Association as being in every way a fit and proper person to be admitted in the Association as Life Member. Name in block letters Life Membership No Signature