MEMBERSHIP FORM - REG.

ANNEXURE ‘A’
Application form for admission as Member of
All India Central Excise Inspectors’ Association (AICEIA)
(To be obtained in quadruplicate)
Applicant’s Name :
(In Block letters)
Designation in the office : INSPECTOR
Date of entry into Service :
Office in which employed :
Residential address :
I declare that the particulars furnished above are correct. I agree to abide by the Constitution, discipline, and directive of the AICEIA. I may be enrolled as a member of the AICEIA..
Station :
Date : Signature & Initial
(To be filled in by the Office Bearer of Branch/Circle)
Name of the Branch in which the applicant
Is admitted as a primary member :
Name of the Circle : CHANDIGARH CIRCLE
Receipt No. issued to the Applicant : N.A

Signature of the President / Secretary of the Circle
(To be filled in by the Secretary General)
It is certified that Shri / Smt. ______________________________________________________________
Is a member of the All India Central Excise Inspectors’ Association (AICEIA).
Signature of the Secretary General, AICEIA

Letter of Authorisation
I, ______________________________________________________________ (Name and Designation) being a member of the All India Central Excise Inspectors’ Association, hereby, authorise deduction of monthly subscription of Rs. 40/- (Rupees fourty only) from my salary and authorize its payment to All India Central Excise Inspectors’ Association, Chandigarh Circle. The subscription for the financial year 2010-11 amounting to Rs 480/- (Four hundred eighty) may be deducted in lumpsum. This deduction may be made @ Rs. 40/- per month till I withdraw my option in writing.

Signature & Initial of the member