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    Application Form For Library Membership: (For Officers and Employees)

    Uploaded by

    Mahesh Raghvani
    This document is an application form for library membership at the Commissionerate of Information in Gujarat, India. It requests information such as the applicant's name, date of birth, gender, official designation and department, contact details, and a declaration that the information provided is true. If selected for membership, the applicant agrees to abide by library rules, return materials on time, and pay any fees for lost or damaged items. The form also includes a section for endorsement by the applicant's head of department.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form For Library Membership: (For Officers and Employees)

    Uploaded by

    Mahesh Raghvani
    53 views2 pages
    This document is an application form for library membership at the Commissionerate of Information in Gujarat, India. It requests information such as the applicant's name, date of birth, gender, official designation and department, contact details, and a declaration that the information provided is true. If selected for membership, the applicant agrees to abide by library rules, return materials on time, and pay any fees for lost or damaged items. The form also includes a section for endorsement by the applicant's head of department.

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    Original Title

    Officers and Employees

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    This document is an application form for library membership at the Commissionerate of Information in Gujarat, India. It requests information such as the applicant's name, date of birth, gender, official designation and department, contact details, and a declaration that the information provided is true. If selected for membership, the applicant agrees to abide by library rules, return materials on time, and pay any fees for lost or damaged items. The form also includes a section for endorsement by the applicant's head of department.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    53 views2 pages

    Application Form For Library Membership: (For Officers and Employees)

    Uploaded by

    Mahesh Raghvani
    This document is an application form for library membership at the Commissionerate of Information in Gujarat, India. It requests information such as the applicant's name, date of birth, gender, official designation and department, contact details, and a declaration that the information provided is true. If selected for membership, the applicant agrees to abide by library rules, return materials on time, and pay any fees for lost or damaged items. The form also includes a section for endorsement by the applicant's head of department.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Commissionerate of Information

    Government of Gujarat
    GANDHINAGAR

    Application Form for Library Membership


    [For officers and employees]

    Category (Please select the relevant category)


    Passport
     Employee size
    photo
     Others

    ________________________________________________________________________

    Name (in capital): ______________________________________________________

    Date of Birth: ________________ Gender: Male/Female

    Official Information:

    Designation: ______________________________________

    Department: ___________________________________________________________

    ___________________________________________________________

    Date of Retirement: ___________________

    Contact Information

    Office Address: _________________________________________________________

    _________________________________________________________

    Residence Address: _____________________________________________________

    _____________________________________________________

    Email: (Official) _______________________________________________________

    (Personal) _______________________________________________________

    Phone (O): _____________ Phone (R): _____________ Mobile No: ______________


    1
    Page
    I,_________________________________________ declare that the
    aforementioned information provided by me are true and the best of my knowledge, If
    found false will lead to a cancellation of membership and result in further official action.
    I agree to take care of borrowed material and return it by the due date or a recall
    date.
    I also agree to pay overdue charges, fines & replacement costs for lost /damaged material
    and also authorize my H.O.D/Controlling officers to deduct the same from my salary if
    needed and pay the SCL library.
    I hereby agree to abide by the rules and regulations of library in force from time to
    time.
    Date: _________________

    Place: ________________ Signature of Applicant

    _____________________________________________________________________
    Endorsed by Head of Department or Authorized Officer

    Name: __________________________________________________________________

    Designation: _______________________

    Department: _____________________________________________________________

    Phone (O): _________________ Phone (M): __________________

    Email : __________________________________________________________________

    Date: __________________ Signature & Seal: __________________

    ________________________________________________________________________

    For office Use only

    Membership ID: _______________

    Member Code: ________________

    Valid up to: ___________________

    Life Membership Fees : Rs.500.00 Receipt No.: _________ Date:___/____/_____

    Yearly Membership Fees: Rs.100.00 Receipt No.: ________ Date:___/____/_____

    Seal of Approval Librarian (Authority)

    ---------------------------------------------------------------------------------------------------------------------
    2

    Address: Block No: 11, 2nd Floor, New Sachivalay, Gandhinagar 382010. Ph:23252193
    Page

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