The Grand Lodge of Antient Free and Accepted Masons of Scotland

Application For Initiation

by

Mr.

Lodge.

No.
APPLICANT

Your FULL Name

Address

Post/Area Code

Telephone: Home Day

How long have you resided at the above address? years If less than 3 years state previous address

How long there? years

Occupation Place of Work

Date of Birth 19 Place of Birth

Do you believe in a Supreme Being? Yes / No

Have you ever applied for Membership of another Masonic Lodge? Yes / No If Yes, give details

Have you been convicted of any crime or offence, other than convictions which are "spent" under the Rehabilitation

of Offenders Act (or similar legislation)? Yes / No If Yes, give details

Are you aware of any pending prosecution? Yes / No

Have you any family connection with Freemasonry? Yes / No If Yes, give details

Why are you interested in becoming a Freemason?

I have read the "Guide for Applicants" and have a reasonable understanding of the basic principles of Freemasonry. Being

aware of the main responsibilities of Freemasons, I hereby APPLY to be admitted to membership of the Scottish Craft as a

Member of Lodge No

(If any of the above information is incorrect or misleading you may be liable to action which could affect your Membership)

For the purposes of The Data Protection Act (or similar legislation) I CONSENT to my personal details being retained on computer or by other

electronic means.

Signed Date 20

SPONSORS

PROPOSER: Your FULL Name

Address

Post/Area Code

Telephone: Home Day

SECONDER: Your FULL Name

Address

Post/Area Code

Telephone: Home Day

Proposer Seconder

How long have you known the Applicant? years years

Do you know him well? Yes / No Yes / No

Do you confirm that, to the best of your knowledge and belief, and after

enquiry of the Applicant, his answers in this Application are truthful? Yes/No Yes/No

If admitted, do you accept personal responsibility for encouraging and

instructing him? Yes/No Yes/No

 PROCESSING OF APPLICATION (for completion by Lodge Secretary)

1 Application received by Lodge Secretary on 20

2. Application read at Regular Meeting and remitted to Committee of Enquiry on 20

3. Recommendation of Committee of Enquiry

4. Date of Ballot 20 Result

5. Date of Initiation 20

SUPPLEMENTARY DECLARATIONS

I, the Applicant, met with the Enquiry Committee on 20

I CONFIRM:-

(1) Statements and Questions, described to me as "Standard", were put to me.

(2) All information given by me to that Committee and all information in the foregoing Application is truthful,

accurate and reliable.

(3) The Committee explained to me that, if I am admitted, any wrong or misleading information given by me about myself or in

connection with my application could affect my Membership.

Signed (Applicant) Date 20

We, the Proposer and Seconder, DECLARE, to the best of our knowledge and belief, all information in this Application Form and

also all information given by us to the Enquiry Committee about the Applicant is truthful, accurate and reliable.

Signed (Proposer) Date 20

Signed (Seconder) Date 20

Signed by each of the above in our presence

Signed (Master) Date 20

Signed (Secretary) Date 20