INDIAN INSTITUTE OF BANKING & FINANCE

ORDINARY MEMBERSHIP APPLICATION FORM

Note : See Instructions before filling up the form. To, The Chief Executive Officer Indian Institute of Banking & Finance Dear Sir, I offer myself for being admitted as an Ordinary Member of Indian Institute of Banking & Finance. 1) Full Name Mr./Ms./Mrs. :

(As Recorded with Employer) 2 Office/Residential Address for communication (DO NOT REPEAT NAME)

STATE 3) 5) 6) 7) 8) 9) Date of Birth : Day : Month : Year :

PIN CODE 4) Sex (M/F)

Qualification: (a) Educational.. (b) Professional (such as LLB,C. S., C. A. etc.): ... Bank / Institution working with:..Branch Date of Joining Bank / Institution: Day : Month : Year :

Phone: .... Fax:.. STD code :. e-mail: . Draft Details: Draft No. Draft Date Drawee Bank and Branch Draft Amount

Applicants one colour Photograph of 1 x 1 size duly signed across by applicant (to be stapled here)

Being payment towards Enrollment fee and ONE-TIME Subscription 10) DECLARATION: a) I hereby declare that all the information given in this application is true, complete and correct. I understand that in the event of any information being found false or incorrect subsequent to allotment of membership, my membership is liable to be cancelled / terminated. b) I further declare that I have not at any time been a member of the Institute/applied earlier for membership of the Institute. c) I hereby agree, if admitted, to be bound by the Memorandum and Articles of Association of the Institute. I am aware that, if admitted as an Ordinary Member, as per the provisions of the Articles of Association of the Institute, I shall be liable, in the event of the Institute being wound up, to contribute towards its liabilities a sum not exceeding Re.1/-. d) I confirm having read and understood the rules and regulations of the Institute and I hereby agree to abide by the same. In case I am desirous of instituting any legal proceedings against the Institute I hereby agree that such legal proceedings shall be instituted only in courts at Mumbai, within the state of Maharashtra and not in any other court. Date: Place: Signature of the Applicant:

PARTICULARS FOR MEMBERS IDENTITY CARD

For Office use only

1) Full Name Mr./Ms./Mrs. :

(As Recorded with Employer)

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Bank / Institution working with: . Branch.

SPECIMEN SIGNATURES (to be signed in two boxes)

Applicants one colour Photograph of 1 x 1 size duly signed across by applicant (to be stapled here)

INSTRUCTIONS TO APPLICANTS 1) 2) The application is to be filled in CAPITAL letters only. Membership of the Institute is open only to the staff of recognized banking / financial Institutions / Corporations in India which are in the list of Institutional members of the Institute. Membership application form must be completed in all respects and forwarded to the Institute alongwith the enrollment fee and membership fee amounting to Rs.1,100/-. If the form is incomplete or defective in any respect, it would be returned / rejected by the Institute. The details of fees to be paid at the time of admission are as under: Enrollment Fee Rs. 100/- AND ONE-TIME MEMBERSHIP FEE Rs. 1,000/-

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Applicants falling under Southern, Eastern and Northern Zone may submit Membership applications alongwith a MICR demand draft in favour of "State Bank of India A/c Indian Institute of Banking & Finance", and made payable at Chennai, Kolkata and New Delhi as the case may be. Applicants who come under Western Zone must enclose a MICR demand draft in favour of "Canara Bank A/c - Indian Institute of Banking & Finance", and made payable at Mumbai. Please ensure that Non-MICR draft is not used for making payment and the draft should have the validity period of atleast 6 months. Membership number will be sent within fortnignt, if the Membership Application form is found to be in order. A permanent I-card will be issued to the candidates which should be produced at the time of examination and whenever demanded for availing other services. The addresses of the four Zonal Offices alongwith the Corresponding States falling under each Zone are given below:

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Western Zonal Office

(Gujarat, Madhya Pradesh, Chattisgarh, Maharashtra, Rajasthan, Goa, Dadra and Nagar Haveli, Daman & Diu). DEPUTY DIRECTOR - Indian Institute of Banking & Finance, 191, Maker Towers 'F', Cuffe Parade, MUMBAI 400 005 Tel.No.: 022-2183302, Fax: 022-2180845 Email: iibwz@iib.org.in

Southern Zonal Office

(Andhra Pradesh, Karnataka, Kerala, Tamilnadu, Lakshwadeep, Pondicherry) DEPUTY DIRECTOR - Indian Institute of Banking & Finance, 61, Arya GowdaRoad, West Mambalam, CHENNAI 600033 Tel.No.: 044-4746961, Fax: 044-4746966 Email: iibchen@vsnl.net

Eastern Zonal Office

(Assam, Bihar, Manipur, Meghalaya, Mizoram, Nagaland, Orissa, Sikkim, West Bengal, Andaman & Nicobar Islands, Arunachal Pradesh, Tripura, Jharkhand) DEPUTY DIRECTOR - Indian Institute of Banking & Finance, 'Anandlok', 3rd Floor, 227, Acharya J.C. Bose Road, KOLKATA 700020. Tel.No.: 033-2809681/82/83 Fax: 033-2809680 Email: iibez@iib.org.in

Northern Zonal Office

(Haryana, Himachal Pradesh, Jammu & Kashmir, Punjab, U.P., Uttaranchal Delhi, Chandigarh). DEPUTY DIRECTOR- Indian Institute of Banking & Finance, 11A, Atmaram House, Tolstoy Marg, NEW DELHI 110001 Tel.No.: 011-3354921, 3354316 Fax: 011-3351165 Email: iibnz@iib.org.in HELP US TO SERVE YOU BETTER: Please write all the details legibly in this application form. Please send your application form and all your communications to the appropriate Zonal Office only under which your state falls. It is necessary to inform any change in your address immediately, to the Zonal Office under which your state falls to enable us to provide you all the services.

NOTE : APPLICATION FORM ALONGWITH THE PHOTOGRAPH SHOULD BE SENT TO ZONAL OFFICE

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