Form 1A

CHAMBAL AGRICULTURE MARKETING COOPERATIVE LTD

(Under Ministry of Cooperation, Govt. of India)
Regd. Office : 525, Rajput Nagar, Bharouli Road, Bhind, Madhya Pradesh – 477001

Registration No. : MSCS/CR/1305/2021 dated 15/01/2021 issued by the Central Registrar of Cooperative Societies,
Department of Cooperation, Ministry of Cooperation, Government of India.
Area of Operation : Madhya Pradesh and Uttar Pradesh
Contact : +91-9826260123, +91-9424853300 E-mail : [email protected] Website : www.camcolimited.com

Already Ordinary Member of this Society (Please tick  appropriate box) – Yes ( ) No ( )
If YES then please provide below mentioned details:
Membership No.: …………………………………….
(For Individuals only)
MEMBERSHIP & SHARE APPLICATION FORM

To,
PHOTO
THE CHAIRMAN/CHIEF EXECUTIVE OFFICER, SIGNATURE
CHAMBAL AGRICULTURE MARKETING COOPERATIVE LTD
525, RAJPUT NAGAR, BHAROULI ROAD, BHIND,
MADHYA PRADESH – 477001

Dear Sir,

I hereby apply for Membership of the Society and tender a sum of ₹ …………....….. for ₹ 100 as Membership Fees and
₹……….…....….. for ……….. no. of shares of 500/- each.
Further, I have read the bye-laws of the Society on the date of application for Membership. I intend to actively participate in
promoting objects and functions of the Society as mentioned in clause 4 of the bye-laws duly registered with the Central Registrar of
Cooperative Societies, New Delhi and undertake to abide by the Bye-Laws of the Society or any amendments made there under, the
Multi State Cooperative Societies Act, 2002 and Rules made there under. Kindly consider my application for Ordinary Membership.

1. PERSONAL DETAILS

A. Name of Applicant : .
B. Father’s/Spouse Name : .
C. Residential Address : .
(as per Address Proof)
District : State : Pin Code : .
D. Telephone/Mobile : R: O: .
E. E-Mail ID : Nationality : .
F. PAN No. (attached a copy) : Form 60/61: .
G. Date of Birth (attached a copy) : (applicant should be 18 years of age) .
H. Identification Documents : i. Identity Proof - (Please Tick  Appropriate Document)
(Please attach a self attached copy) Aadhaar Card/Voter Card/Passport/Driving Licence/Other Documents.
ii. Address Proof - (Please Tick  Appropriate Document)
Aadhaar Card/Voter Card/Passport/Driving Licence/Other Documents. .
I. Occupation : .
J. Nominee Details : Name : Age/Date of Birth : .
Relation : Contact No.: .
Residan : .
In case of minor, Guardian drtails Mr./Ms.: Age/Date of Birth : Relation : .
K. Details of Bank Account : Bank Name : Account No.: .
(Applicant’s Account)
Type of Account (Saving/Current) : IFSC Code : .
Branch Name and Address : .
2. PAYMENT DETAILS : (No Membership fees is required, if applicant is already a Ordinary Member of this Society.)
A. ₹ _____________ (in words : ___________________________________________only) for ₹ 100 as Membership Fees and
₹ ________________ for _______ no. of Shares of 500/- each.
B. Mode of Payment : Cash/Cheque/DD/NEFT*/RTGS* : (please tick  as applicable)
In case payment via Cheque/DD/NEFT/RTGS No. : date drawn in favour
of “ CHAMBAL AGRICULTURE MARKETING COOPERATIVE LTD”
* For NEFT/RTGS : Account Name : CHAMBAL AGRICULTURE MARKETING COOP LTD
Account No.: 40036608340 IFSC Code : SBIN0010839 Branch : COLLECTORATE BHIND

Date : ___________ Signature of Applicant

Place : ___________

Witness -
Signature :
Name : Address : .

ENCLOSED :
1. DD/Cheque of ₹ _______________ (in words) __________________________________________________________only
2. Address Proof : Aadhaar Card/Voter Card/Passport/Driving Licence/Other Documents
3. ID Proof : Aadhaar Card/Voter Card/Passport/Driving Licence/Other Documents
4. PAN Card : Self Attested Copy
UNDERTAKING & DECLARATION
I, the undersigned, do hereby declare that –
1. The above mentioned particulars/informations given by me are true and correct and nothing has been concealed there from.
2. I am not member of any other Multi State Cooperative Society or Cooperative Society of the same class, and it is clear to me that I
can not avail membership of two societies at the time. In case of becoming member of any other society which is in similar to this
Society, I shall automatically cease to be member of this Society.
3. I have read (I was explained in my language) the terms and conditions of Bye-Laws of this society, a copy of the same received by
me, and do agree to bride the same.
4. I am resident of India.
5. I am competent to contract as per Section 11 of the Indian Contract Act, 1872.
6. I am not a minor and have attained the age of 18 years at the time of applying for Membership.
7. I have not been adjourned by the competent court to be insolvent or undischarged insolvent.
8. I have not sentenced for an offence other than political character or offence not involving moral turpitude and dishonesty, a period
of 5 years has lapsed from date of expiry of the sentence.
9. I have not involved directly or indirectly in any kind of business in conflict or competitive with the business of the society.
10. I undertake that I shall accept the decision of the management of the society in respect of approval or rejection of my application.
Note : The member can transfer his/her Share(s)as per the Bye Laws of the Society and in compliance with the provisions of the
Multi State Cooperative Societies Act, 2002 and Rules made there under, after completion of 1(one) year as Member/Shareholder.

Signature of Applicant

FOR OFFICE USE ONLY

Member Name : ________________________________________
Membership No : ________________________________________
The board/committee of the Board of CHAMBAL AGRICULTURE MARKETING COOPERATIVE LTD vide resolution dated
_______________ Accepted/Rejected the application for Membership and decided to allot ___________ no. of Shares ₹ 500/- each.
For order of Board of Chambal Agriculture Marketing Cooperative Ltd.

CEO/Authorised Signatory
Date : __________________
Place : __________________