Name of Institutional :

Head of Institutional :

Office Contact No:

mobile No:

Email Id:

Date of Registration of Institutional:

Institutional Registration Number:

Permanent Address:

City:

State:

We hereby affirm my allegiance to the constitution of India and undertake to uphold its provisions in my personal, official and public life.

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

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

We hereby conform that we are not involved in any criminal cases.

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

I Accept

Signature