T.S.CENTRAL STATE LIBARARY, CHANDIGARH Application for Membership (For bonafide residents of Chandigarh, Panchkula and Mohali) (Please Fill in Block Letters) Name : Mr/Ms. Sex : Male/Female Father's/Husband's Name: Mr. Year of Birth To be filled in by student only Roll No. Class Name of the Institute Tel. No. Sector Village To be filled by non-student only Occupation/Designation : Organisation/Deptt. Name: Sector Village Tel. No. (Office) Residential Address House No. Sector Village Tel. No Date Signature of the Applicant Recommendation Certified that he/she is : 1. A temporary/permanent Govt employees 2. A bonafide student of this School/College Signature and Seal of the Head (Name in Block letters) Tel. No. ________________ 1. Persons not employed/ Pensioners working in private organisations have to get their form attested by a Gazetted Officer posted in Chandigarh / Mohali / Panchkula. 2. School/ College students must get their form attested by Headmaster or Principal. 3. Full name of the attesting authority should be mentioned in block letters. 4. Banks / Corporations / Boards / Autonomous Bodies will be considered in General Category. 5. Proff of residential address to be attached. * Tick whichever is applicable For Office use only Membership No : Amount Recd : Rs Date Receipt No : Occupation : Organisation Code State Code Librarian C. S. Library, Chandigarh 1. I make application for membership of the library. I shall abide by its rules. 2. I hold myself responsible for the books issued on my membership card. 3. I undertake to notify change of my official / residential address promptly to the library. 4. I shall surrender my membership card on my leaving Chandigarh. 5.I have recieved my membership card. Signature of the Applicant
