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Bio Data Form

WELLINGTON GYMKHANA CLUB

BIO-DATA OF PROSPECTIVE MEMBERS PERSONAL DATA

(YOU CAN ALSO USE SEPARATE SHEETS IF REQUIRED)

PERSONAL DATA

  1. Name            :
  2. Date of Birth & Age :
  3. Father’s/ Husband’s Name :
  4. Marital Status             :
  5. Details of Family (Spouse and Children)

Spouse Name   :………………………………………..Occupation…………………………………

Children Name                                                            Sex                 Date of Birth & Age

(a)

         (b)

         (c)

 

  1. Present Address incl Tele No & E-mail :

 

 

  1. Permanent Address incl Tele No & E-mail :

 

 

  1. Nationality :

(Please attach copy of passport)

 

PROFESSIONAL DETAILS                                               

  1. Educational/Professional Qualifications    :
  2. Details of Occupation / Employment /

Service for at least last ten years                  :

 

 

  1. Office address and Tele No’s                       :

 

  1. Employer’s address & Tele No’s                  :

 

  1. Annual Income                                               :

(Attach photo copy of Income Tax Returns for previous two years)

 

  1. PAN No :

(Please attach your Income tax Returns for previous two years)

 

MISCELLANEOUS & SOCIAL

  1. Member of other Clubs & institutions along with photocopy of membership card.
  2. Are any of your relatives members of this Club? If so, please give details.
  3. Have you been expelled from any other Club? If so, please give details.
  4. Have you been charged / involved in any criminal offence? If so, please give details.
  5. What type of membership you are seeking – Resident / Non-Resident
  6. If resident give details of property/residential house in Nilgiris.

 

 

 

(Signature of Proposer & Membership No.)                                (Signature of Candidate/ Proposer)

 

Place:

Date:

Note : This form to be used only for Civilian Membership.

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Annual General Body Meetng is scheduled on 09 November 2017 at 5 pm.