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PSWA Membership Application Form - 2022

PSWA Membership Application Form - 2022

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lilykuzhali
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40 views2 pages

PSWA Membership Application Form - 2022

PSWA Membership Application Form - 2022

Uploaded by

lilykuzhali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

APPLICATION FOR MEMBERSHIP

PROFESSIONAL SOCIAL WORKERS' ASSOCIATION


(PSWA)
E-mail: [email protected] / www.PSWA.org.in

Since 1985 Office: PSWA, C/o MACT, 39/8, Starling Apartments, Akbarabad 2nd Street, Ko-
dambakkam, Chennai - 600024. Tamil Nadu State, India.
Tel.: +91-44-24721579. Mobile: 9444020563/ 9092091636.

KINDLY FILL ALL THE DETAILS IN CAPITAL LETTERS.

Member Status : Student /Practitioner

Membership Type : Student / Professional Recent Colour Photo


to be pasted and
Name of the Applicant : attested by applicant
with date
Father’s Name(expansion of Initial) :

Date of Birth :

Permanent Address :

Communication Address :
(If different from Perm. Address)

Contact Ph. / Mobile / FAX :

Contact Email :

Year of Passing MSW / MA (SW) :

Specialization (if any) :

College Name & Address :

Other Qualifications (if any) :

Occupation : Self-Employed / Govt. / NGO / Funding Agency/


Academic / Others (Specify)______________

Designation at work (if any) :

Organization Name / Contact Details :

PSWA – Application for Membership


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Payment Details:

Membership Fee (Tick): Rs.100 (Student) / Rs.3000 (Professional*)


Mode: Cash /Cheque /Demand Draft (Please add Rs.50/- for outstation cheque).
Payment should be made only in favour of “Professional Social Workers' Association”
payable at Chennai.

* it is mandatory for Professional Members to renew their membership every five years

DECLARATION

 Enclosed please find a Cheque / DD / Cash for Rs.__________/- (being the membership
fee for Student / Professional Membership). The Cheque / DD may be encashed incase
my Application is approved by the PSWA, otherwise returned to me for Cancellation.
Cheque / DD No._______________ dated__________________ drawn on Bank &
Branch__________________________________________________________________

 I_________________________________________________________hereby solemnly
affirm that I shall abide as per terms & conditions of the Association and to respect the
constitution of the PSWA and all the directives issued by the Association from time to
time.

Place:

Date: Signature of Applicant

Enclosures:
1. A Recent Passport Size & Stamp Size Photograph for the purpose of issuing Membership
Identity Card and Certificate.
2. Self-Attested Copy of MSW / M.A(SW) Degree Certificate / Copy of Student Identity
Card (for Student membership).
3. Self-Attested Copy of MSW / M. A(SW) Course Transfer Certificate.
4. Self-Attested Copy of Permanent/Communication address proof with Photo Identification.

Note: Application to be sent only to Office Address as above.

OFFICE USE ONLY

The above ______________Membership Application has been ACCEPTED /


REJECTED at the Executive Committee / Office Bearers meeting held on
_______________.

President, PSWA Secretary,


PSWA

Application Received Receipt No.


Date
Membership No. Receipt Date

PSWA – Application for Membership


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