Indian Civil and Administrative Service (Central)

PHOTO OF CHILD (Stamp size) (optional)

PHOTO OF CHILD (Stamp size) (optional)

PHOTO OF FATHER (Stamp size) (optional)

PHOTO OF MOTHER (Stamp size) (optional)

NAME OF OFFICER TITLE DR MR MS

FIRST NAME

MIDDLE NAME SURNAME BATCH & CADRE DATE OF BIRTH & SEX EDUCATIONAL QUALIFICATION NAME OF SPOUSE BATCH & CADRE (if in Service) DATE OF BIRTH & SEX EDUCATIONAL QUALIFICATION DATE OF MARRIAGE NAME OF CHILDREN DATE OF BIRTH NAME OF CHILDREN DATE OF BIRTH OFFICERS PERSONAL E-MAIL OFFICERS PERSONAL CELL NOS SPOUSES PERSONAL E-MAIL SPOUSES PERSONAL CELL NOS 1) D D 3) D D D D M M M M Y Y Y Y Y Y D D M M M M Y Y Y Y Y Y D D D D M M M M B/G Y Y B/G Y Y Y Y 2) D D 4) D D D D M M M M Y Y Y Y D D M M M M Y Y Y Y Y Y Y Y Y Y B/G Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y MALE FEMALE D D D D M M M M Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y MALE FEMALE D D D D M M M M Y Y

B/G

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Indian Civil and Administrative Service (Central)

OFFICE ADDRESS

HOME ADDRESS

NAME OF FATHER NAME OF MOTHER LIFE MEMBERSHIP FEE DETAILS Name of the Bank Cheque / Deman Draft No Date of Cheque / Deman Draft ANY OTHER INFORMATION D D D D M M M M Y Y Y Y Y Y Y Y D D D D M M M M Y Y Y Y Y Y Y Y Payable at New Delhi

DATE CITY STATE

SIGNATURE OF MEMBER

Terms and conditions: 1. I hereby declare that I have voluntarily applied for the Membership of the Indian Civil and Administrative Service (Central) Association, New Delhi. 2. I have carefully read all the Rules and Regulations of the Association and hereby undertake that I would comply with the Rules and Regulations. 3. The statements made in this application are true, complete and correct to the best of my knowledge and belief. 4. I understand that in the event of any particular or information given herein being false or incorrect, my Membership is liable to be cancelled and in the event of any mis-statement / discrepancy in the particulars being detected in my application, my Membership is liable to be terminated without any notice to me. 5. Please send your cheque for Rs. 5,000/-, payable at New Delhi, in the name of Indian Civil and Administrative Service (Central) Association. 6. Till next AGM Please send your cheque to Shri. Amardeep S Bhatia, Joint Secretary, DoCA & Hon. Treasurer, ICA&AS(C) Association, Room No. 505, A Wing, Shastri Bhawan, Dr. Rajendra Prasad Road, New Delhi-110001.

7. Please write your name, batch, cadre, present posting / address, personal email and personal cell number on
the reverse of the cheque also. 8. Though photographs of family members and names of parents are optional but it is requested that if it is provided then it would help the Association to build the database of the Members for various social occasions.

FOR OFFICE USE ONLY

Date of Receipt of Application D D D D M M M M Y Y Y Y Y Y Y Y Date D D D D M M M M Y Y Y Y Y Y Y Y Signature of Secretary Date D D D D M M M M Y Y Y Y Y Y Y Y Received By Signature Remarks

Signature of Treasurer

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