M.NO.

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The Film Writer's Association
Registration no. 3726
(Registered under the The Indian Trade Union Act 1926)
201/202, Richa, Plot : B-29, Off Link Road, Andheri (W), Mumbai - 400 053.
Tel: 2673 3108, 2673 3027 Fax : 6692 2899 E-mail: tfwa@vsnl.net

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Membership Form Date:__________________
¬¸¢¸¨¸/Hon. General Secretary
¢™ ¢ûöö¥Ÿ¸ £¸ƒ’¬¸Ä ‡¬¸¸½¢¬¸‡©¸›¸
The Film Writer's Association
Mumbai - 400 053.

Ÿ¸ÿ ‚¸œ¸ˆÅú ¬¸¿¬˜¸¸ ˆÅ¸ ¬¸™¬¡¸ ¤¸›¸›¸½ ˆÅ¸ ‚›¸º£¸½š¸ ˆÅ£ £í¸ / £íú í»Â — ‚œ¸›¸½ ¤¸¸£½ Ÿ¸½¿ ¢›¸Ÿ›¸¢¥¸¢‰¸÷¸ ¬¸»¸›¸¸‡¿ ™½ £í¸ /£íú í»Â —
I request you to enroll me as a member of the Association. Particulars regarding me are as follows :-

›¸¸Ÿ¸ /Name _______________________________________________________________________________

¢œ¸÷¸¸ / œ¸¢÷¸ ˆÅ¸ ›¸¸Ÿ¸

Father's/ Husband's Name _________________________________________________________________

„ŸÏ/ Age _____________________ ¸›Ÿ¸ ÷¸¸£ú‰¸/ Date of Birth __________________________________

©¸¾®¸¢μ¸ˆÅ ¡¸¸½Š¡¸÷¸¸/ Educational Qualification _____________________________________________________

¢£¥¸ú¸ö íºƒÄ ¢ûöÅ¥Ÿ¸ /¬¸ú¢£¡¸¥¸/ ‚¸Á¢”¡¸¸½ ˆÁŬ¸½’/‚¥¸¤¸Ÿ¸

Released Picture/Serial/Audio Cassette/Album _________________________________________________

¢£¥¸ú¸ö ˆÅ¸ ¨¸«¸Ä/ Year of Release _____________________________________________________________

¢ûÅö¥¸í¸¥¸ Ÿ¸ÿ ¢¥¸‰¸ £í¸/£íú í»

At present I am writing _________________________________________________________________

œ¸÷¸¸ / Address___________________________________________________________________________

_______________________________________________ûŸ½›¸/Telephone___________________________

E-mail_______________________________________ Ÿ¸¸½¤¸ƒÄ¥¸ /Mobile______________________________

Ÿ¸¾¿ ¬¸÷¡¸ž¸¸¨¸ ¬¸½ ‹¸¸½¢«¸÷¸ ˆÅ£÷¸¸/ˆÅ£÷¸ú í»Â ¢ˆÅ „œ¸£¸½ˆ÷¸ ¢¨¸¨¸£μ¸ ¬¸¸ ‡¨¸¿ ¬¸íú í¾¿ ÷¸˜¸¸ Ÿ¸º¸½ ¬¸¿¬˜¸¸ ˆ½Å ¢›¸¡¸Ÿ¸ ¬¨¸úˆÅ¸£ í¾ — Ÿ¸ÿ „›¸
›¸‡ ¢›¸¡¸Ÿ¸¸½¿ ˆÅ¸½ ž¸ú Ÿ¸¸›¸›¸½ ˆÅ¸½ ¤¸¸š¡¸ í»Â ¸¸½ ¬¸Ÿ¸¡¸-¬¸Ÿ¸¡¸ œ¸£ ¤¸›¸¸¡¸½ ¸¸¡¸½¿Š¸½ —
I solemnly declare that the above mentioned particulars are true and correct and I agree to abide by the existing
rules and regulations of the constitution which I have read, as well as those that may be formed time to time.

________________________
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Note: Proposed & Seconded by our Life & Regular Member only. Signature of Applicant
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Proposed by___________________________ M.No._____________ Signature__________________
¬¸Ÿ¸˜¸Ä›¸ ¬¸.ÇÅ. í¬÷¸¸®¸£
Seconded by___________________________ M.No._____________ Signature__________________
 ˆÅ¸¡¸¸Ä¥¸¡¸ „œ¸¡¸¸½Š¸ ˆ½Å ¢¥¸‡ /For Office Use Only
¢›¸Ÿ›¸¢¥¸¢‰¸÷¸ £¸¢©¸ ¸¾ˆÅ ׸£¸/ ›¸ˆöÅ™ œÏ¸œ÷¸ ˆÅú / Received the money as below:

‚¸¨¸½™›¸ œ¸°¸ / Application Form Rs . . . . . . .

œÏ¨¸½©¸ ©¸º¥ˆ / Admission Fee Rs. . . . . . .

¨¸¸¢«¸ÄˆÅ ©¸º¥ˆ. / Subscription for one year From_____________ To ___________ Rs. . . . . . .

œ¸í¸¸›¸ œ¸°¸ / Identity Card Rs. . . . . . .

¬¸¿¢¨¸š¸¸›¸ œ¸º¢¬÷¸ˆÅ¸ / Constitution Book Rs. . . . . . .

™¸›¸ (¬¨¸½Ž¸ ¬¸½) / Donation (Voluntarily) Rs. . . . . . .

œ¸¢£¬¸¿‹¸ ©¸º¥ˆ / Confederation Fee Rs. . . . . . .

ˆºÅ¥¸ / Total Rs. . . . . . .

œÏ¸œ÷¸ ˆÅ£÷¸¸Ä ˆ½Å í¬÷¸¸®¸£

£¬¸ú™ ›¸¿./ Receipt No.______________ ¢™›¸¸¿ˆÅ/Date ____________ Signature of the receiver _____________

•û¾Å¥¸¸½ ¬¸™¬¡¸ / Fellow Member

•‡¬¸¸½¢¬¸‡’ ¬¸™¬¡¸ / Associate Member

•¢›¸¡¸¢Ÿ¸÷¸ ¬¸™¬¡¸ / Regular Member

•‚¸¸ú¨¸›¸ ¬¸™¬¡¸ / Life Member

¢’œœ¸μ¸ú ¬¨¸úˆÅ¸¡¸Ä
Remarks Approved by
Chq.No: ____________Date:______________

Bank Name ____________________________

Branch________________________________
‚¸Á›¸£½£ú ¸›¸£¥¸ ¬¸½Ç½Å’£ú
Hon. General Secretary

¬¸™¬¡¸÷¸¸ ›¸¿ / Membership No. ____________________

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