BILL NO…. … …. …. …. …. …. … …  MEMBERSHIP CODE:… …. …. …. … …. …. … … … …. …  

     ALL BENGAL CONTRACTUAL WHOLE TIME

    TEACHERS’ ASSOCIATION

  Regn No.: S/IL/ 85844   

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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 :

	DEGREE	SUBJECT	% OF MARKS	UNIVERSITY	YEAR OF PASSING
GRADUATION
POST-GRADUATION
NET / SET
M.Phil. / Ph.D.
OTHERS

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 : _______________________________________________________________________