Individual Membership Form

Student/Individual Membership Form of Anti-Corruption Academy

Annual MemberLife MemberHonorary Member

    A.Primary Members Information
  1. Name
  2. Father's Name
  3. Date of Birth
  4. Nationality
  5. Blood Group
  6. Address
  7. City
  8. Postal Code
  9. State
  10. Mobile Number
  11. Home Telephone
  12. Fax
  13. Email
  14. Academic Qualification
  15. Professional Qualification, if any
  16. Occupation
  17. Incase Service, name of the company/Organization
  18. Incase Business, nature of Business
  19. Office Address
  20. Telephone Number
  21. Fax
  22. If you are member of any other Anti Corruption Academy/ Committee, mention the name of such academy/ committee, address & the year of its establishment
  23. Whether the applicant's application for membership of this Academy was rejected or withdrawn at any time: If Yes, give details
  24. Whether the applicant's application for membership was rejected or withdrawn at any other Academy/ Committee:If Yes, give details
  25. Have you ever been charge sheeted for corruption or any criminal act:If Yes:give details
  26. Have you 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
  27. Name of the Spouse
  28. Date of Birth
  29. Blood Group
  30. Occupation
  31. I 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 dated drawn on for Rs. (Entrance fee Rs. + Annual Subscription fees + Life Membership fees Rs.
  32. Please attach a copy of PAN card
  33. I 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.
  34. Date
  35. Signature of the Applicant
  36. Signature of Proposer
    • Membership No
  37. Signature of the Seconder
    • Membership No

Category of Member Admission fee Annual fee Lifetime
- Indian INR 2,500 INR 10,000 INR 50,000
- Foreigner USD 100 USD 2,000 USD 10,000
- Student INR 500 INR 2,000 __________

(First 5000 student will get benifit of lifetime for free after their academics)