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Corporate Membership Form






Annual MemberLife Member

    A.Personal Profile
  1. Name of Company Organization/ Firm
  2. Address
  3. Pin
  4. Please attach a copy of address proof
  5. Tel Off
  6. Fax
  7. Website
  8. Email
  9. (a) Nature of Organization
  10. (b) Nature of Employee
  11. Name, Designation and Address of Nominees(Maximum Four)

  12. 1st Nominee
  13. Name
  14. Designation
  15. Address
  16. Pin
  17. Tel Off
  18. Fax
  19. Tel Res
  20. Email
  21. Mobile
  22. 2nd Nominee
  23. Name
  24. Designation
  25. Address
  26. Pin
  27. Tel Off
  28. Fax
  29. Tel Res
  30. Email
  31. Mobile
  32. 3rd Nominee
  33. Name
  34. Designation
  35. Address
  36. Pin
  37. Tel Off
  38. Fax
  39. Tel Res
  40. Email
  41. Mobile
  42. 4th Nominee
  43. Name
  44. Designation
  45. Address
  46. Pin
  47. Tel Off
  48. Fax
  49. Tel Res
  50. Email
  51. Mobile
  52. Whether the applicant or its nominees are the member of any other Anti Corruption Academy/ Committee, mention the name of such academy/ committee, address & the year of its establishment
  53. Whether the applicant's application for membership of this Academy was rejected or withdrawn at any time:If Yes, give details
  54. Whether the applicant's applicantion for membership was rejected or withdrawn at any other Academy/ Committee:If Yes, give details
  55. Have the applicant or its nominees been charge sheeted for corruption or any criminal act:If Yes, give details
  56. Have the applicant or its nominees ever been convicted by a court of any offence, whether involving moral turpitude or otherwise, and sentenced in respect thereof to imprisonment: If Yes, give details
  57. We agree to abide by the Memorandum of Association and Rules & Regulations of the Academy as in force from time to time and enclose a cheque/bank Draft No
  58. Dated
  59. Drawn On
  60. For Rs.
  61. (Entrance Fee Rs.
  62. + Annual Subscription fees
  63. + Life Membership fees Rs.)
  64. Please attach a copy of PAN Card
  65. We further certify that the above inforamtion is true to the best of my knowledge and belief. The Membership is liable to be cancelled if the information furnished is found to be incorrect.
  66. Signature along with the seal of the company
  67. Name
  68. Desgination
  69. Date
  70. Signature of Proposer
  71. Membership No
  72. Signature of Seconder
  73. Membership No

Category of Member Admission fee Annual fee Lifetime
Body Corporate/Institutions INR 10,000 INR 1,00,000 INR 5,00,000

Corporate Membership Form






Annual MemberLife Member

    A.Personal Profile
  1. Name of Company Organization/ Firm
  2. Address
  3. Pin
  4. Please attach a copy of address proof
  5. Tel Off
  6. Fax
  7. Website
  8. Email
  9. (a) Nature of Organization
  10. (b) Nature of Employee
  11. Name, Designation and Address of Nominees(Maximum Four)

  12. 1st Nominee
  13. Name
  14. Designation
  15. Address
  16. Pin
  17. Tel Off
  18. Fax
  19. Tel Res
  20. Email
  21. Mobile
  22. 2nd Nominee
  23. Name
  24. Designation
  25. Address
  26. Pin
  27. Tel Off
  28. Fax
  29. Tel Res
  30. Email
  31. Mobile
  32. 3rd Nominee
  33. Name
  34. Designation
  35. Address
  36. Pin
  37. Tel Off
  38. Fax
  39. Tel Res
  40. Email
  41. Mobile
  42. 4th Nominee
  43. Name
  44. Designation
  45. Address
  46. Pin
  47. Tel Off
  48. Fax
  49. Tel Res
  50. Email
  51. Mobile
  52. Whether the applicant or its nominees are the member of any other Anti Corruption Academy/ Committee, mention the name of such academy/ committee, address & the year of its establishment
  53. Whether the applicant's application for membership of this Academy was rejected or withdrawn at any time:If Yes, give details
  54. Whether the applicant's applicantion for membership was rejected or withdrawn at any other Academy/ Committee:If Yes, give details
  55. Have the applicant or its nominees been charge sheeted for corruption or any criminal act:If Yes, give details
  56. Have the applicant or its nominees ever been convicted by a court of any offence, whether involving moral turpitude or otherwise, and sentenced in respect thereof to imprisonment: If Yes, give details
  57. We agree to abide by the Memorandum of Association and Rules & Regulations of the Academy as in force from time to time and enclose a cheque/bank Draft No
  58. Dated
  59. Drawn On
  60. For Rs.
  61. (Entrance Fee Rs.
  62. + Annual Subscription fees
  63. + Life Membership fees Rs.)
  64. Please attach a copy of PAN Card
  65. We further certify that the above inforamtion is true to the best of my knowledge and belief. The Membership is liable to be cancelled if the information furnished is found to be incorrect.
  66. Signature along with the seal of the company
  67. Name
  68. Desgination
  69. Date
  70. Signature of Proposer
  71. Membership No
  72. Signature of Seconder
  73. Membership No

Category of Member Admission fee Annual fee Lifetime
Body Corporate/Institutions INR 10,000 INR 1,00,000 INR 5,00,000