J&K STATE CENTRAL LIBRARY JAMMU/SRINAGAR Membership Application Form Two stamp size (3.5x2.5 cms.) latest photographs I Desire to become a member of Lending Section of the State Central Library/District Library/Taluka Library/Village Library. I have read the Rules and Regulations and agree to abide by them. I shall take proper care of the Library books and undertake to replace any book/s lost or damaged by me. I shall notify to the Library any change in my address. Full Name:-........................ (In block letters beginning with Surname) Permanent Address:-.................... Present Address: -...................... ..................... Phone No.: -............. Age (for children's only):-............ Profession/Designation:-............... (for State/District/Taluka Libraries) and required deposit Name and address of educational Institution/Office/ ............... Organization (for student and working people only) Nationality and passport No. .............. (for foreign nationals only) Specimen Signature (FOR OFFICE USE) Reg. No. ............. Date of Reg. ............ Curator Receipt No. .... . Book No. ..... Amount Deposited Rs. ....... Date of renewal of membership ........ Date of withdrawal of membership. ....... Amount Refund Rs. ......... Signature of Member ........... UNDERTAKING I ............................ .hereby agree to abide with the following conditions: 1. That I shall return the Book within the specified time limit. 2. That care will be taken to see that the Book is handled properly/carefully and no danger is caused to the Books. 3. In the event of any damage caused to the Book issued to me, during the period, I undertake to pay cost of the Book to the Librarian/Government. Date:-........... Signature of the Applicant NOMINATION I Dr./Shri /Smt. /Kum. /Mast./................. to hereby authorize/nominate .............................. (relationship) .............................. who shall claim the refund of Library deposit on my behalf in the event of my death/Permanent Migration outside the State. Date:-Signature:Place:-Name: Witness:-1) Name:-........... Signature: 2) Name: -..................................... Signature:
