U

GENERAL GUIDELINES FOR FILLING UP

MEMBERSHIP APPLICATION
Defence Officers (Serving / Retired) desirous of seeking club membership are requested
to note the following:(a)
Please read the application form carefully and fill up all the columns as
applicable.
(b)
The form is to be countersigned by CO / O I/C / Director in case of Serving
Officers who are borne in that organization on permanent duty. Officers borne on
temporary duty / courses / attachment etc are not eligible for membership of the
club.
(c)
Existing rates of refundable Security Deposit, to be paid by cheque, are as
follows:(i)
(ii)

Serving Officers
Retired Officers

Rs.5,000.00
Rs.8,000.00

(d)
Please ensure your form is complete in all respect and hand it in to the main
office in person. It will be scrutinized by the Office Superintendent and accepted or
rejected for want of proper documentation. If rejected you are required to further
complete documentation and then hand it into the Main Office.
(e)
The form will be processed and if membership is granted you will be
informed and a membership number will be allotted to you.
(f)
Two copies of (stamp size) photographs of self and dependent family
member / s are to be put in the envelope provided with application and submitted
to the Card Section. (Indicate name on reverse side of photographs).
(g)

Service Officers are requested to provide their photographs in uniform.

(h)
Retired Officers are NOT to give a photocopy of their IAFIC. Photocopy of
the ex-servicemens ID card issued by DSSAB is to be given.
(i)
Photo copies of the birth certificates / s of dependent children are to be
attached along with application.
(k)
Parent / brothers / sisters are not considered as dependent for the purpose
of club membership. Only legally wedded spouse and children i.e. unmarried sons
below 25 years and unmarried daughters.
(l)
Monthly bills and newsletter will not be sent to members. These are posted
on the Clubs website www.usclub.co.in. Members are requested to look these up
on the website.

PARTICULARS OF MEMBER
(SERVICE OFFICER ON ACTIVE LIST)

MEMBERSHIP
NO.

Service No._____________ Present Rank _______________Date of Birth ________________

Name in full (Surname First) _____________________________________________________
Present Unit / Ship in Mumbai where borne on permanent duty with address. _______________
____________________________________________________________________________
Residential Address. ___________________________________________________________
____________________________________________________________________________
Permanent Address. ___________________________________________________________
____________________________________________________________________________
Telephone. Office. _______________________ Residence. ____________________________
Mobile No. __________________________ E-mail ID. ________________________________
Bankers with Address. __________________________________________________________
Bank A/c No. _________________________________________________________________
Service Account No. _____________________ Married / Single _________________________
Were you a member before if so when? _____________ Old Mship No. __________________
Golfer

Non Golfer

* DETAILS OF FAMILY *
(a) Spouse _____________________________________ Date of Birth __________________
(b) Children
Name

Date with year

of Birth

If Authorised
to sign chits

(i) ----------------------------------------------------------------------------------------------------------------(ii) ---------------------------------------------------------------------------------------------------------------(iii) ---------------------------------------------------------------------------------------------------------------Date of Application ----------------------------

Signature of Applicant --------------------------------

Date of Approval -------------------------------for Membership

Certified that the Officer is borne in my unit

on permanent duty and his unit is based in
Mumbai.

Signature of Chief Executive -----------------of US Club

Signature of Commanding --------------------------Officer and Unit stamp

Membership No. ______________

UNITED SERVICES CLUB, MUMBAI

MEMBERS DATA SHEET
PLEASE FILL UP IN BLOCK CAPITAL LETTERS

PHOTO

NAME (IN FULL) _____________________________________________________________

DATE OF BIRTH _____________________________________________________________
FOR DEFENCE OFFICER ONLY (ARMY / NAVY / AIR FORCE)
RANK _____________________________________ SERVICE NO. ____________________
DATE OF COMMISSION ______________________ ________________________________
PRESENT APPOINTMENT _____________________________________________________
LIKELY DATE OF RETIREMENT ________________________________________________
MEMBERSHIP ALLOTTED (DATE) ______________________________________________
SPECIFY WHETHER: SERVING / PENSIONER / WIDOW-PENSIONER / NON-PENSIONER
CATEGORY OF MEMBERSHIP: SERVING / RETIRED / WIDOW-SERVICE / SC / ONP / TM /
HLM / LM / PERMANENT CIVILIAN / GSP / GSA / GSH / GOV / ING / IG / CRP / SOC / CIVILWIDOW

DETAILS OF FAMILY:
(A)

NAME OF SPOUSE ______________________________________________________

(B)

DATE OF BIRTH _____________________SIGNATURE_________________________

(C)

DEPENDENT CHILDREN: (PLEASE ATTACH XEROX OF BIRTH CERTIFICATE)

(UNMARRIED SONS UPTO 25 YEARS AND UNMARRIED DAUGHTERS ONLY)
SR. NO.

NAME

DATE OF BIRTH

SIGNATURE

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
(D)

LOCAL ADDRESS:
BILLING

OFFICE

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PERMANENT ADDRESS (IN FULL INCLUDING PIN CODE)

TELEPHONE (RES) _____________________________ (OFFICE) _____________________

MOBILE NO. ___________________________________

FAX NO. ____________________

E-MAIL ID ___________________________________________________________________
PAN NO. ____________________________________________________________________

DETAILS OF SAVING BANK ACCOUNT

DETAILS OF PENSION BANK ACCOUNT

(FOR RETIRED DEFENCE OFFICER ONLY)

_________________________________

_____________________________________

_________________________________

_____________________________________

_________________________________

_____________________________________

1.

IT IS CERTIFIED THAT I WILL COMMUNICATE IN WRITING ANY CHANGE OF ADDRESS,

MEMBERSHIP CATEGORY, TELEPHONE NUMBER ON MY TRANSFER / RETIREMENT FROM

SERVICE / CHANGE OF STATION. IT IS UNDERSTOOD BY ME THAT MY MEMBERSHIP MAY BE
TERMINATED BY THE CLUB MANAGEMENT IF THE ABOVE DETAILS ARE FOUND TO BE
INCORRECT.

2.

ALL TM MEMBERSHIP ARE FOR ONE CALENDAR YEAR DURATION ONLY AND RELEVANT

DOCUMENTS (MEMBERS RESIDENCE PROOF AND LETTER FROM OFFICE) WILL BE RESUBMITTED YEARLY FOR CONTINUATION OF MEMBERSHIP.

DATE ______________________

SIGNATURE OF THE MEMBER ________________

___________________________________________________________________________

FOR CLUB OFFICE ONLY

TERMINATION OF MEMBERSHIP IN ANY (DATE) __________________________________
REASONS __________________________________________________________________
OWN REQUEST / TRANSFER / DEFAULTERS / CHANGE OF STATION / DEATH /
DISCIPLINARY GROUNDS / RETIREMENT FROM PRESENT APPOINTMENT.
DY. SECRETARY (FINANCE)

_____________________

OFFICE SUPERINTENDENT

_____________________

I CARD SECTION

_____________________

CORRESPONDENCE CLERK

_____________________

UNITED SERVICES CLUB

PLEASE FILL IN BLOCK CAPITAL LETTERS
PLEASE SEND TWO PHOTOGRAPHS EACH AND INDICATE NAME ON REVERSE
SIDE OF PHOTOGRAPHS
MEMBERSHIP NO. :
______________________________________________________________________
1.

NAME OF MEMBER: _______________________________________________

2.

NAME OF SPOUSE: _______________________________________________

3.

NAME OF DEPENDENT 1: _____________________ AGE ___________

4.

NAME OF DEPENDENT 2: _____________________ AGE: __________