Form J

Rule 12-A
APPLICATION FOR MEMBERSHIP
(Application to be submitted in person or through RPAD)

Pillalamarri Village, Fishermen Co-operative Society, Suryapet District Fishermen Co-

operative Officer, Registrar.

1. Name of the applicant : Gowni Parshuramulu

2. Father Name : Saidulu
3. Age : 41
4. Residence : Pillalamarri
5. Occupation : Fishing
6. Society/Bank
1. G.O.M.S. No. 476, Food and Agri (Co-IV) Department dt: 24-5-1976, included.
2. G.O.M.S. No. 668, Food and Agri (Co-IV) Department dt: 29-7-1976, placed in
place.

7. Bankrupt/Redemption from bankrupt : No

8. Whether prosecuted in any crime, if so date : No
9. Employee of bank for Society :
10. If yes for 8 and 9, are you being protected :
Under section 21 (2)
11. Date of removal of membership from society : No
12. Doing any pawn business or given Rs. 100/- : No
To 5 persons in a year.
13. Have you satisfied the byelaws of society : Satisfied
To become its member
14. Are you ready to pay the total as per Registrar : Rs. 55/-
(a) Minimum Share : Rs. 50/-
(b) Entry Fee : Rs. 5/-
15. Process of Payment : SCR-9-Challan
(a) If through Moneyorder, PO of that post office
Receipt number, date.
(b) If paid in Co-Operative Society Bank Branch
Branch name, Challan, date

Note:
1. Application must only be sent along with the copy of the receipt of the minimum
entry fee or bank challan.
2. You should not disallow the payment and shall make a note on the duplicate
application of the total received with challan number in writing.

I state that the above mentioned facts are in my knowledge and believed to be
true.
Sd/-
XXXX
Witness
1.Sd/-XXX
2.Sd/-XXX
Sd/-XXXX
President
Pillalamari Fishermen Co-operative Society
Pillalamari Village, Suryapet Mandal.

Sd/-XXXX
Secretary
Pillalamari Fishermen Co-operative Society
Pillalamari Village, Suryapet Mandal.