INDIAN INSTITUTE OF BANKING & FINANCE

ORDINARY MEMBERSHIP APPLICATION FORM (please see instructions before filling up the form)

To,

Membership
(to be allotted by the Office)

No.
Chief Executive Officer Indian Institute of Banking & Finance Dear Sir, I, as an employee of the bank/financial institution mentioned below, 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

PINCODE

COUNTRY

3) 4) Date of Birth : Day : Month :

Nationality Year : 5) Sex (M/F)

6) Qualification: (a) Educational.. (b) Professional (such as LLB,C. S., C. A.,MBA., etc.): ... 7) Bank / Institution working with:. .Branch Designation 8)Date of Joining Bank / Institution: Day : Staff No. Month : Yeyear : City Code.: email.

9) Phone: .... Fax:.. Country Code :. 10)Draft/Payorder Details: Draft No. Draft Date Drawee Bank and Branch

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

Draft Amount

11)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) c)

d)

I further declare that I have not at any time been a member of the Institute/applied earlier for membership of the Institute. 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/-. 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. Place: Signature of the Applicant:

Date:

PARTICULARS FOR MEMBERS IDENTITY CARD Membership No. 1) Full Name Mr./Ms./Mrs. :

For Office use only

(As Recorded with Employer)

2)

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) 3) 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 and abroad Membership application form must be completed in all respects and forwarded to the Institute alongwith One Time Membership Fee of Rs.1,500/- for applicants from India and US $ 150 for applicants from other countries.

4)

Submission of membership application form with Demand Draft for the requisite amount be drawn in favour of "Indian Institute of Banking & Finance" payable at city where the respective zonal office is located - SZO-Chennai, NZO-Delhi, EZO-Kolkata, WZO-Mumbai
Membership number will be sent within a month, if the Membership Application form is found to be in order.

5) 6) 7)

A permanent I-card will be issued to the Members 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 and also of the Corporate Office are given below:

Western Zonal Office

(Gujarat, Madhya Pradesh, Chattisgarh, Maharashtra, Rajasthan, Goa, Dadra and Nagar Haveli, Daman & Diu). DEPUTY DIRECTOR - Indian Institute of Banking & Finance, 193, Maker Towers 'F', 19th floor, Cuffe Parade, MUMBAI 400 005 Tel.No.: 022-22185134/2183302, Fax: 022-22180845 Email: iibwz@iibf.org.in

Southern Zonal Office

(Andhra Pradesh, Karnataka, Kerala, Tamilnadu, Lakshwadeep, Pondicherry) DEPUTY DIRECTOR - Indian Institute of Banking & Finance, No.94, Jawaharlal Nehru Road (100 Feet Road), Opp. To Hotel Ambica Empire , Vadapalani, CHENNAI - 600 026, Tel.No.s.044-24722990, 24728325, Fax:044-24726966, Email: iibsz@iibf.org.in

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, 408, Anandlok, 4 th Floor , 227, Acharya J.C.Bose Road , Kolkata - 700 020, TelNos.033-22809681/82/83, Fax:033-22809680, Email: iibez@iibf.org.in

Northern Zonal Office

(Haryana, Himachal Pradesh, Jammu & Kashmir, Punjab, U.P., Uttaranchal Delhi, Chandigarh). DEPUTY DIRECTOR- Indian Institute of Banking & Finance, Vikrant Tower , 1st Floor, 4, Rajendra

Place, New Delhi 110008, Telephone: 011-25752191/92, Fax: 011-25752193, E-Mail: ibnz@iibf.org.in
Corporate Office (for Overseas Members) DEPUTY DIRECTOR, Corporate Development & Membership, Indian Institute of Banking & Finance,World Trade Centre,The Arcade, 2nd floor, Cuffe Parade, Mumbai 400 005. Tel.No.022-22187003/4/5 Fax:022-22185147 Email: mem-services@iibf.org.in NOTE Please write all the details legibly in this application form. Please send your application form and all your communications to the appropriate Office only under which your state falls. Overseas members may send their form to the Corporate Office. It is necessary to inform any change in your address immediately, to the concerned Office to enable us to provide you all the services

-oOo-