Individual Membership

    Individual Membership Form


    Annual MemberLife MemberHonorary Member

    Registration
    1. Name

    2. Father's Name

    3. Date of Birth

    4. Nationality

    5. Address

    6. City

    7. Postal Code

    8. State

    9. Mobile Number

    10. Home Telephone

    11. Fax

    12. Email

    13. Academic Qualification

    14. Professional Qualification, if any

    15. Occupation

    16. Incase Service, name of the company/Organization

    17. Incase Business, nature of Business

    18. Office Address

    19. Telephone Number

    20. Fax

    21. If you are member of any other Anti Corruption Academy/ Committee, mention the name of such academy/ committee, address & the year of its establishment

    22. Whether the applicant's application for membership of this Academy was rejected or withdrawn at any time: If Yes, give details

    23. Whether the applicant's application for membership was rejected or withdrawn at any other Academy/ Committee:If Yes, give details

    24. Have you ever been charge sheeted for corruption or any criminal act:If Yes:give details

    25. 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

    26. Name of the Spouse

    27. Date of Birth

    28. Blood Group

    29. Occupation

    30. 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.

    31. Please attach a copy of PAN card

    32. 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.

    33. Date

    34. Signature of the Applicant

    35. Signature of Proposer

      • Membership No

    36. Signature of the Seconder

      • Membership No

    Category of Member

    Admission fee

    Annual fee

    Lifetime

    Individual

    - 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

    __________

    Undertaking
    1. I hereby affirm my allegiance to the constitution of India and undertake to uphold its provision in my personal, official and public life.

    2. I hereby certify that all the information furnished with this application are true.

    3. I undertake that I will not make use of ACA(Anti-Corruption Academy) for any personal gain nor put its logo and name on my personal letterhead or any other document. In case of violation of the undertaking or any breach og conduct, ACA India will be free to terminate my Membership.

    4. I hereby confirm that I am not involved in any Corruption?Criminal cases.

    5. I Accept

    6. Signature


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