BILL NO…. … …. …. …. …. …. … … MEMBERSHIP CODE:… …. …. …. … …. …. … … … …. …
ALL BENGAL CONTRACTUAL WHOLE TIME
TEACHERS’ ASSOCIATION
Regn No.: S/IL/ 85844
Affix a recent passport size colour photograph
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2A, Sudha Apartment, 39 Third Bye-Lane, Subhasnagar, Dumdum Cantonment, Kolkata-65, Blog Id: www.wbftclinfo.blogspot.in
email:abcwtta@rediffmail.com
MEMBERSHIP APPLICATION FORM
(To be filled in BLOCK letters only)
NAME:Mr./Mrs.__________________________________________
DATE OF BIRTH _________BLOOD GRP:_______CATEGORY : GEN /SC /ST /OBC
FATHER’S NAME: Mr._____________________________________________________________
PERMANENT ADDRESS: ___________________________________________________________
________________________________________________________________________________
MAILING ADDRESS: _____________________________________________________________
________________________________________________________________________________
EMAIL ID : ____________________________________________________________________________________
PHONE NO. RES-___________________________MOBILE:____________________________________________
ACADEMIC ACHIEVEMENTS :
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M.Phil. / Ph.D.
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COLLEGE DETAILS
NAME OF THE COLLEGE :___________________________________________________________
ADDRESS OF THE COLLEGE : _______________________________________________________
____________________________________________DISTRICT: ____________________________
UNIVERSITY: ______________________________________________________________________
WEBSITE OF THE COLLGE: www.__________________________EMAIL ID: __________________
NAME OF THE PRINCIPAL: Dr. _______________________________________________________
PHONE NO.: PRINCIPAL-________________OFFICE-_____________STAFF ROOM_____________
DATE OF JOINING AS CWTT : ____________________CONCERNED DEPT.:__________________
APPROVAL MEMO NO. & DATE: ______________________________________________________
I Mr./ Mrs. _______________________________________________________________ hereby declare that every information above is absolutely true to the best of my knowledge and I possess documentary evidences to substantiate above information.
DATE: _______________________________________
PLACE: ______________________________________ SIGNATURE : _______________________
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FOR OFFICE USE
BILL NO: ____________________ MEMBERSHIP CODE:_________________________________
UNIVERSITY : ____________________________________________________________________
COLLEGE : _______________________________________________________________________