Pune City Tamil Sangam
                       B No: 1, Supreme Palm Balewadi Phata Baner, PUNE 411 045 INDIA
	Membership Application Form	
Please visit/ Logon to our					
Website: http://www.punetamilsangam.org
E-mail:  punecitytamilsangam@gmail.com				
1) Name:_________________________________________________*	Date of Birth :______________________	
			Blood Group :______________________	
2) Spouse Name:___________________________________________	Date of Birth :______________________	
3) Marriage Anniversary :____________________________________			
4) Address:________________________________________________*			
__________________________________________________________			
__________________________________________________________			
5) Tele Nos Off :__________________________	Resi:______________________	

6)	Mobile No:____________________________   *(for communication)

7)	E-Mail Address:__________________________________________ *

8)	Occupation Self:_________________________________________* 

9)	Spouse:________________________________________________ 

10)	Hobbies:______________________________________________ 

_________________________________________________________ 

11) Signatories:___________________________________________*     Date:____________*

12) Proposed By:___________________________________________    Sign & Date:_______________

Office Use

Application accepted/rejected : ________/_________/____________

(secretary/President)
If Rejected – Reason for the same_____________________

Signature of Hon. President: ______________________________

Signature of Hon. Secretary: _____________________________

Payments: Corpus & subscription : Rs: _____________

Received in Cash / Cheque No: ___________ DT: _____/______/________ Drawn on_________

Bank Details for ONLINE transfer 

A/c No: 111001000117825
IFSC Code: CIUB0000111

City Union Bank Ltd.,
Branch Somwar Peth ,    CTS NO. 327, Pride Crystal Show Room, No.1, Somwar Peth, Pune 411011