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Application Form for Primary Membership

❖ Personal Details:

Title (Mr/Mrs/Ms): _______ Full Name: __________________________________________________________________________

Date of Birth: ____/____/_______ PAN Number: ____________________ Aadhaar Number: ________________________________

Address for Correspondence:

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________ Pin : _______________________ State:________________________________
Permanent Address:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________ Pin : _______________________ State: _______________________________

Email: ____________________________________________________ WhatsApp No.: ____________________________________

Mobile Number: _____________________________________________ Landline No.: ____________________________________

❖ Academic Details:

Year of
Qualification University/Council Subject / Stream Percentage
Passing

Professional Qualification: ______________________________________________________________________________________

Memberships (If any): _________________________________________________________________________________________

Work Experience: ____________________________________________________________________________________________

Additional Information:
____________________________________________________________________________________________________________

Have you ever been convicted for an offence?

Yes No

Are any criminal proceedings pending against you?

Yes No

Have you ever been declared as an undischarged bankrupt, or applied to be adjudged as Bankrupt?

Yes No

Please provide any additional information that may be relevant for your application. (Type "NA" if not available)
❖ AFFIRMATIONS

I am not disqualified from being registered as a valuer under the Companies (Registered Valuers and Valuation) Rules, 2017.

This application and the information furnished by me along with this application is true and complete. If found false or misleading at
any stage, my registration shall be summarily cancelled.

I hereby undertake to comply with the requirements of the Companies Act, 2013, the rules made there under, the directions
given by the authority, and the bye-laws, directions and guidelines issued or the resolutions passed in accordance with the bye-
laws by the registered valuers organization with which I am enrolled.

❖ Documents:

1. Copy of proof of Residence:

________________________________________________________________________________________________________

2. Copies of documents in support of educational qualifications, professional qualifications and Registered Valuation
Examination qualifications:

________________________________________________________________________________________________________

3. Copies of documents demonstrating practice or work experience for the relevant period:

________________________________________________________________________________________________________

4. Copies of certificate of employment by the relevant employer(s), specifying the period of such employment:

________________________________________________________________________________________________________

I hereby declare that the submitted information is true to the best of my knowledge and belief and I shall be held responsible
for any false statement. I have gone through the details whatever written.

Place: _______________________ Date: _______________ Signature: ______________________________