MUDRA AGRICULTURE & SKILL DEVELOPMENT

MULTI STATE CO-OP. SOCIETY LTD.

(Regd.No.MSCS/CR/1273/2017)
Regd. Off : 15/A, 3-4-757/22, APHB Building Near Raghavendra Swamy Temple,
Opp.Telangana Grameena Bank, Barkatpura, Hyd - 27.
Central Off : 2-1-477, Lower Ground Floor, Prateek Towers, Opp.Post Office, Near SBH,
Main Road, Nallakunta, Hyd. - 44. Phone : 040 - 27675565

SHARE APPLICATION FORM

Application No.: ...........................Membership No. ......................... Account No. : ..........................

1. Name of Applicant
2. Father’s /Husband’s Name
3. Full Postal Address
(With Pin Code)

4. Phone Number with STD Code

5. Mobile Number

6. E-mail ID

7. Age & Date of Birth

8. Occupation

9. Religion

10. Parish/Locality

11. State

12. Mandal

13. Village

14. Pan Card

15. Aadhar Card

16. Share Amount Deposited

Rs. :...............................

In Words : ....................................................................................................

Mode of Payment Cash:

(Tick the Appropriate Box) Cheque :

Bank Name : ..........................
Cheque Number : ............................................. Cheque Date : ..................

Bank Deposit :
Name of bank : ....................................
Name of branch : ..................................
 17. Details of Nominee

a Name

b Relationship

c Full Postal Address

(With Pin code)

18. Details of existing Bank Account

a Name as in the Passbook

b Account Number

c Name of the Bank

d Name of the Branch

I agree to be a member of the Society subject to the rules and regulations of the approved bylaws of
the Society and future amendments to the same.

Place : Signature of the Applicant

Date :

FOR OFFICE USE ONLY

Received Rs. (Rupees ....................................................................

...........................................................................................................................................................)

Nember of Shares allotted

Shares may be allotted subject to the bylaws of the Society and MSCS Act 2002.

Administrative Officer Branch Manager/Branch Incharge

Decision of the Board : Membership granted / Not granted

Membership Number : Date of membership

Signature of Manager ........................................... Date : ....................................