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  APPLICATION / AGREEMENT FORM
       
  1 Applicant's Name :  
  2 Father/ Husband's Name :  
  3 Marital Status :
Married
Un Married
  4 Age & Date OF Birth :  
  5 Sex :
Male
 Female
 
  6 Profession :
Employed
 Business
 House Wife
  7 Monthly Income/ Salary :  
  8 Permanent Address :  
  9 Address To Correspondence :  
  10 Pin :  
  11 Taluk :  
  12 Village :  
  13 Desom / Kara  
  14 Post Office :  
  15 Phone / Mobile  
  16 E - mail :  
       
  17 NAME OF THE NOMINEE  
  18 Age :  
  19 Relationship :  
  20 Address :  
  20 Pin :  
.
     

 
 

Dear Sirs,
Having completely read or caused to be read fully understtod the rules governing the conduct of the chit and assented to the same, a copy of which I/we have signed and delivered to you. I/we send sum of Rs..................................(Rupees.........................................................................................................................................Only) By Money order / Cheque /DD remittance in cash at ............................................... being payment on .............................................ticket due for the first instalment which I/we request to allot me / us. Although the chit is proposed to be started by you from.................................. .I/ we agree to any change in the date of commencement or any change in the place of draw and auction of the Chit.

  
 
Yours Faithfully  
Signature OF the Applicant's  
 
 
Signature OF the witness :  
Place :  
 
  Date :  
     
 
Our Banks
Catholic Syrian Bank                            IFS Code : CSB 0000094
State Bank Of India   IFS Code : SIB B0000084
 
 
 
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