M.D.
(Ay.)/ M.S. (Ay.) ENTRANCES TEST, U.P.S.C., STATE & CENTRAL SERVICES
PRELIMINARY TEST PREPARATION
(Chotiwala's Ayurveda, 492, C. P. Mission Compound, Near Preeti Provisional Store, Gwaliar Road, Jhansi - 284003)
Serial No.
Membership
Code :
Receipt
No.
(To be filled by the office)
To, Anju Sachan
w/o Dr. Sanjay Kumar Singh
Chotiwala's Ayurveda
492, C. P. Mission Compound, Near Preeti Provisional Store,
Gwaliar Road, Jhansi - 284003
Paste Your Recent Stamp Size Photograph
Here
Madam, I
S/o- W/o-D/o
do hereby
request you to grant me membership in the following category : (Tick
whichever is applicable)
Group
I
Group
II
Group
III
Group
IV
Group V
Group
VI
Group
VII
Group
VIII
Member's
Particulars
1.
Name
2.
Sex
Male
Female
3.
Father's
/Husband's Name
4.
Age
5.
D.O.B
6.
Qualification
7.
Occupation
8.
Permanent
Address
9.
Address for
orrespondence
10.
Phone No.
Residence with S.T.D.
-
11.
Phone No. Office
with S.T.D
-
12.
Mobile
No.
13.
Email
14.
PAN No. (With
designation of Officer-Circle/Ward/Place)
Declaration
I have
read all the rules and regulations regarding the membership for
Chotiwala's Tutorial & Guidance elaborated after the
application form and objectives of
Chotiwala's Tutorial & Guidance attached with the
application form. I shall abide by the concerned rules and
regulations concerned. In the event of violation of concerned
rules and regulations under any circumstances by me, the
Chotiwala's Tutorial & Guidance is independent to
take any disciplinary action against me without assigning any
reason thereof and I shall be entirely responsible for it.
I,now,request you to enroll me as a member as per rules and
regulations of the
Chotiwala's Tutorial & Guidance.
