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THE CHARTERED ACCOUNTS BENEVOLENT FUND
C/O. THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA
I.P. MARG P.O. BOX NO. 7100, NEW DELHI - 110 002.
(APPLICATION FORM FOR LIFE MEMBERSHIP OF THE FUND)

NO. (LM )

Dear Sir,

I hereby apply for admission as a Subscriber Member of the Chartered Accountants Benevolent Fund. I am remitting with Rs. 2500/- towards any subscription as Life Member. This amount of Rs. 2500/- shall form of the corpus of the fund. I have read the Rules & Regulations of the fund and I agree to abide by them, and also by the Rules that may be made hereafter. I give below the necessary particulars.

1. Full Name : ----------------------------------------------
2. Address : ----------------------------------------------

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3. a) Membership No. : ----------------------------------------------
  b) Date of Enrolment : ----------------------------------------------
  c) Whether Fellow or Associate : ----------------------------------------------
  d) Address for communication : ----------------------------------------------
4. Name of dependents and relations : ----------------------------------------------


Name Age Relation
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Life Membership Fee Rs. 2500/-

Yours faithfully,

(SIGNATURE OF THE MEMBER)

PLACE :

DATE :

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