Mem. No.

meervejeFme& SmeesefmeSMeve
SCREENWRITERS ASSOCIATION
REGISTERED UNDER TRADE UNION ACT 1926 REGISTRATION NO. 3726
201-204, RICHA, PLOT NO. B-29, OPP. CITY MALL, OFF. NEW LINK RD., ANDHERI (W), MUMBAI - 400 053.
Tel.: 2673 3027, 2673 3108, 6692 2899 E-mail : swaindiaorg@gmail.com filmwritersassociation@gmail.com Website : www.fwa.co.in

meomelee-He$e
MEMBERSHIP-FORM
cenemeefeJe /Hon. General Secretary Date 20

meervejeFme& SmeesefmeSeve
Screenwriters Association
Mumbai - 400 053.

cewQ SmeesefmeSMeve kee meome yeveves kes efueS efveJesove kej jne / jner ntB ~ cesjer Jeefkeleiele peevekeejer Fme ekeej nw ~
I request you to enroll me as a Member of the Association, particulars regarding me are as follows -

veece / Name
efHelee /Heefle kee veece
Father/Husbands Name

Gce /Age pevce leejerKe /Date of Birth

Mew#eefCeke eesielee /Educational Qualification
efjueer]pe ngF& ef]Heuce/meerefjeue/Dee@ef[ees ke@mes/Deueyece
Released Picture/Serial/Audio Cassestte/Album

efjueer]pe kee Je<e& /Year of Release

efHeueneue cewQ efueKe jne /jner ntB ~
At present I am writing

Helee /Address

ceesyeeFue /Mobile
F&cesue /E-mail Heesve /Telephone
cewQ Hetjer meleefve<e kes meeLe en Ieesef<ele kejlee/kejleer ntB efke Ghejeskele efJeJejCe mener nwQ leLee cegPes SmeesefmeSMeve kes efveece mJeerkeej nwQ ~
cewQ Gve veS efveeceesW kees Yeer ceeveves kees yeeOe ntB, pees mecee-mecee Hej yeveees peeesWies ~
I solemnly declare that the above mentioned particulars are true and correct and I agree to abide by the the exiting
rules and regulations of the constitution which I have read as well as those that may be formed time to time.

eeLeer& kee nmlee#ej

Note : Proposed & Seconded by our Life & Regular Member only. Signature of Applicant

emleeJeke / Proposed by Name meomelee e. / Mem. No. nmlee#ej / Signature

............................................................. .................................................. ..........................................

meceLe&ve /Seconded by Name meomelee e. / Mem. No. nmlee#ej / Signature

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 keeee&uee kes Gheeesie kes efueS / For Office Use Only
efvecveefueefKele jeefMe eske eje /vekeo eeHle keer / Received the money as below:

DeeJesove He$e / Application Form Rs...........................

eJesMe Meguke / Admission Fee Rs...........................

Jeeef<e&ke Meguke / Subscription for one year Form To Rs...........................

heneeve He$e / Identity Card Rs...........................

mebefJeOeeve Hegefmlekee / Constitution Book Rs...........................

oeve (mJese mes) / Donation (Voluntarily) Rs...........................

HeefjmebIe Meguke / Confederation Fee Rs...........................

[eke Meguke / Postal Charges Rs...........................

kegue / Total Rs...........................

eeHlekelee& kes nmlee#ej

jmeero veb. / Receipt No. efoveebke / Date Sign. of the receiver

Hesuees meome / Fellow Member

SmeesefmeS meome / Associate Member
efveeefcele meome / Regular Member
DeepeerJeve meome / Life Member

efHHeCeer
mJeerkeee&
Remarks
Approved by
Chq. No. Date:

Bank Name

Branch

ceeveo cenemeefeJe
Hon. General Secretary

eceeefCele kelee&
Verified By