To Place : _____________

The Bank of India Staff Co-operative

Credit and Thrift Society Ltd. Date : _____________
C/o Bank of India,
No. 11, Kempegowda Road.
BANGALORE - 560 009. Phone: 22351 379

Dear Sir/Madam,

Re: Application for enrolment as a member of the Society.

I request you to enrol me as a member of the Society. I am a permanent employee of Bank of India,
...........................................................Branch.
Please find enclosed cheque/W/S for Rs. . ........................................made up as follows.

a) Share Capital Rs. P.

……………Shares of Rs. 100 each ……………
b) Admission Fee 20-00
c) Share Fee at Rs. 10 per Share ……………
d) Thrift Contribution Minimum Rs. 300/- ___________
(Multiples of Rs. 100/-) ___________

I hereby declare that l was/ I was not a member of this Society.

(In case you were a member of this society please give the following details)
a) Date of Membership :

b) Date of Registration :

c) Reasons for resigning :

from the society.

I hereby declare that I am not a member of any other Society.

I agree to abide by the rules & regulations of the Society. I further agree to contribute
Rs.__________ p.m. towards the Thrift Fund of the Society.

Thanking You Yours faithfully

Name :________________

Branch :_______________ (Signature)

 CERTIFICATE FROM THE BRANCH MANAGER

We conform that Mr. / Mrs. / Miss..__________________________________________is a

Permanent employee of Bank of India________________________ Branch.

His/ Her service particulars are as under:
a) Date of Birth :
b) Date of joining :
c) Date of confirmation :
d) Date of Retirement :
e) Present gross emoluments per month :
Attach Salary Slip For Bank of India
f) Salary A/C No. :
g) PF No :
h) Contact No : Manager
i) E-Mail ID :
Place :_______________ _________________Branch
Date :_______________

NOMINATION
I hereby nominate the person mentioned below who shall in the event of my death be entitled
to be paid the amount under deposit and Share amount with accrued interest and dividents therein, if
any to the exclusion of all others.

NOMINEE

a) Name in (Capitals) :

b) Age& Relationship :

c) Full Address :

Signature & Full address of witness

1.

2.
Signature of the Member
Date: Date:
FOR OFFICE USE ONLY
Admitted as Member Membership No____________

L.F. No.__________________

Secretary President