Indian Association for Productivity, Quality & Reliability

INDIAN ASSOCIATION FOR PRODUCTIVITY, QUALITY & RELIABILITY ( Affiliated to the International Statistical Institute ) Address: BB-239, Sector - I, Salt Lake City, Kolkata 700 064. Phone No.: 91-33-2334 6234/33 (12 Noon - 6 p.m.); Telefax: 91-33-2334 6234 Email: [email protected] Application for Admission to Membership

I have gone through the rules and regulations of your society and being interested/ involved in the quality Movement in India, desire to be enrolled as an individual (annual/life)member of society. My particulars are given below. The required fee for

Annual Member: Rs.500 per annum(India);US Dollars 15(Foreign) Life Member : Rs.5000 (India);US Dollars 150(Foreign)[one time] is being sent in cash/Cheque on Kolkata Bank/by Bank Draft drawn in favour of Indian Association for Productivity, Quality and Reliability.

1. Name:

2. Address: a)Office

b)Residence Telephone No. a) Office: ______b)Residence:______

Mobile : e-mail :

3. Occupation (with designation):

4. Qualification (with Specialisation): Date: ______Place: ______Signature

Proposed By: Name: ______Dated Signature: ______Seconded By: Name: ______Dated Signature: ______For Office Use only

Application i) received on ______

ii) placed before the Board of Governors on______

Membership No. ______Membership intimated on ______

N.B. This amount may be paid by Bank Draft or Cheque on Kolkata Bank favouring Indian Association for Productivity, Quality and Reliability or remit the said payment by way of Bank Transfer, details of which are provided herein below : 1. Bank Account (Savings Bank) 025010100158558 2. Beneficiary Name Indian Association for Productivity, Quality and Reliability 3. Address BB-239, Sector-I, Salt Lake City, Kolkata-700 064 4. BANK & Branch Name AXIS Bank, Salt Lake Branch 5. Address BD-20, Sector-I, Salt Lake, Kolkata-700 064 6. MICR Code 700211006 7. Branch Code 025 8. IFSC Code UTIB0000025 9. PAN No. AAAA10786L